Washington Update

Millions Could Gain Dental Coverage Through the Affordable Care Act

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With the inclusion of pediatric oral health services as an essential benefit under the Affordable Care Act (ACA), millions of children are poised to gain dental coverage over the next five years. Some adults will also receive dental benefits as the law is implemented.

The American Dental Association (ADA) estimates that 8.7 million children will receive dental coverage through the ACA, but according to a November article in The Wall Street Journal, some experts place that number at 5 million.

The ACA is expanding Medicaid eligibility in many, though not all, states. Twenty-nine states currently offer at least some dental coverage to adults through Medicaid. The other states offer adults emergency-only coverage or none at all.

Consumers purchasing insurance through the new health insurance marketplaces have the option of purchasing dental coverage separately or as part of their medical insurance plan. The Journal reports that these plans vary considerably in how they structure their deductibles. As a result, some plans may cost consumers more than they would pay out-of-pocket for the care they receive. Out-of-pocket maximums also vary by state, but stand-alone pediatric dental plans in the federally-run exchanges have limits set at $700 for one child and $1,400 for two or more children.

Medicare does not cover routine dental care, and it is anticipated that many consumers, especially older adults, will continue to rely on charitable and subsidized care for their dental needs.  Oral Health America has launched a website, toothwisdom.org, to link older adults with oral health resources in their states, including care sites, financial tools and social support services, such as transportation.

The Wall Street Journal also quoted Dr. Richard W. Valachovic, D.M.D., M.P.H., ADEA President and CEO, on the safety-net role that dental schools play in providing routine and specialty oral health care at reduced fees.

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