Pediatric Dental Coverage in State and Federally-Facilitated Exchanges: The 2014 Plan Year Experience

By: Colin Reusch

Click here to see all presentations from this Forum Session — July 25. 

Pediatric dental services are among the ten essential benefits that qualified health plans (QHPs) must offer in state and federally facilitated marketplaces created under the Patient Protection and Affordable Care Act of 2010 (ACA). These benefits may be provided in stand-alone dental plans, as part of a QHP, or bundled with a QHP. The purchase of pediatric dental benefits is not required by the U.S. Department of Health and Human Services, although some states have made purchase mandatory. Concerns have been raised about the affordability of pediatric dental benefits, especially if families are required to pay two premiums and meet separate deductibles and out-of-pocket maximums. This Forum session gave an overview of the pediatric dental benefit, provided a snapshot of the offerings and take up of dental coverage nationally, and highlighted key issues related to the 2014 plan year implementation. Three states shared their experiences implementing the benefit and their plans for 2015.​

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children ages 6-12 suffered a toothache in the previous six months.
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