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Is the PPACA pushing dental into voluntary benefits?

Mar 25, 2014

As health care reform becomes further solidified at the federal and state level, one area of healthcare remains shaky at best: adult dental. For the past few decades, adult dental care has generally been packaged with employee medical insurance plans. But when the PPACA omitted adult dental coverage, many agencies and businesses began considering the necessity of including adult dental coverage.

Under the Affordable Care Act (ACA), dental services are an essential health benefit for children under the age of 19, although individual states can choose to extend the age limit beyond this baseline. Declaring pediatric dental care an essential health benefit means that, beginning in 2014, all non-grandfathered medical health plans must offer dental benefits for children unless certified stand-alone coverage is available. Non-medically necessary orthodontia is not included in the essential health benefits definition.

The essential health benefit status for dental coverage does not apply to adults. In addition, unlike medical insurance, you do not have to obtain dental coverage to avoid penalties. Thanks to Nathan Solheim at Benefits Pro for allowing me to comment on this recent shift:

“We’ve probably been going down the voluntary route for dental and vision over the past four years, meaning the employee is picking up the premium. The other trend in mid-to-large size groups is self-funding. They know their exposure, so they figure out the annual maximum and they self-fund, but there’s many still in networks.”

But most companies are cautious. No one wants to be the guinea pig, especially as rules continue to shift. Plus, as Solheim mentions, there are still plenty of reasons for employers to continue offering adult dental coverage. Companies have a vested interest in keeping their employees healthy to offset claims.

Professional dental care can diagnose or help prevent common dental problems including toothache, inflamed gums, tooth decay, bad breath and dry mouth. If conditions like these remain untreated, they can worsen into painful and expensive problems such as gum disease or even tooth loss. According to the American Dental Association, more than 16 million children in the United States suffer from untreated tooth decay, which is the most common chronic childhood disease. Regular dental exams can not only treat dental problems but can also identify other serious health concerns, including some types of cancer. Dental coverage will allow you to inexpensively receive preventive and diagnostic care.

There’s also speculation that adult dental will become a mandatory feature of the PPACA over the next few years. Whatever the future of adult dental coverage, people are asking questions about their coverage and becoming more educated about their healthcare options. And that is never a bad thing.