Dental coverage for children in health care act

When it comes to health care, the mouth is often treated separately from the rest of the body, but the Affordable Care Act (ACA) may serve to bridge the gap – at least for children.

Pediatric dental care is included among the 10 essential health benefits within the ACA. Starting in 2014, legislation requires individual and small-group health plans sold both on the state-based health insurance exchanges and the individual market cover pediatric dental services.

“Tooth decay is the most common disease of childhood, and this law will improve access to dental care for many more children,” says Dr. Linda Niessen, clinical professor in restorative sciences at Texas A&M University Baylor College of Dentistry. “However, this law does not include dental benefits for adults; yet research is showing that oral diseases, particularly periodontal or gum disease, can affect overall health conditions like diabetes or cardiovascular disease.”

The change in health policy mainly targets children who have health coverage through private insurance plans. Children covered through state Medicaid programs already receive the dental benefit, although many eligible children are not enrolled, and parents of those enrolled often have difficulty finding a dentist.

Under the ACA, adults purchasing health insurance will be required to purchase dental benefits for their children, either as a benefit included in their medical plan or from a stand-alone dental benefits plan.

It is unclear how the children’s dental benefit will affect premiums.

“Premiums are determined by the number of people covered, the types of services to be provided, the number of people who used these benefits and the costs of the insurance company to administer the benefits,” Dr. Niessen says. “The law does specify that insurance companies must spend 80 percent of the premiums on health care. If not, they must refund portions of the premiums back to the individual.”

Dr. Niessen suggests you compare prices and benefits for different health insurance and dental plans, especially if you want to lower your premiums.

“The language of the health insurance plans may be difficult to understand, so it may be worth the time to understand what benefits you are trading for a lower premium,” Dr. Niessen says.