Skip to main content

See also:

Does the Affordable Care Act include dental insurance?

Dr. Kimberley Gise performs a dental examination at the Dave Pratt Dental Clinic, part of the I.G. Homes Boys and Girls Club in Phoenix, AZ.
Dr. Kimberley Gise performs a dental examination at the Dave Pratt Dental Clinic, part of the I.G. Homes Boys and Girls Club in Phoenix, AZ.
David Wallace/Arizona Republic

Oral Health is Important for Overall Health

First Teeth First provides free dental screenings and fluoride varnish to children ages 0-5 years of age in Phoenix, Arizona and surrounding Maricopa County.
Stacie Scott/Arizona Republic

With the enrollment deadline of March 31, 2014 looming in the near future, understanding the Affordable Care Act and dental insurance can be treading murky waters. Is dental insurance covered under the ACA?

For many Arizonans, the lack of dental insurance is a barrier to seeking dental treatment and achieving good oral health and systemic health. Research tells us that optimal oral health is important to overall health and well-being. Dental disease is linked to diabetes, coronary artery disease, adverse pregnancy outcomes, pneumonia, dementia, school hours lost and employability.

How is dental insurance included in the Affordable Care Act (ACA)?

Under the Patient Safety and Affordable Care Act (ACA or Obamacare), individuals and small businesses without health insurance may purchase coverage through a Health Exchange or Marketplace, by visiting: http://www.healthcare.gov. Qualified health plans within or outside the exchange must offer ten Essential Health Benefits (EHB), including pediatric oral health services.

Under the ACA, states set the benchmark for EHB. In Arizona, children’s care and oral health services seem to be benchmarked as a dental checkup and treatment limited to medical necessity. Adult dental care is not included as an EHB. In many cases although pediatric dental care is offered, it is not mandatory to purchase if available as a standalone plan.

In a nutshell, adult dental insurance is not mandatory under the ACA, however it may still be purchased. Pediatric dental coverage is required but interpreted at the state level. When choosing any dental insurance plan, be sure to read the fine print and determine the exact coverage.

Medicaid Expansion increases State Medicaid Eligibility (AHCCCS) for Eligible Arizonans

Some Arizonans may be eligible for Medicaid which includes pediatric dental benefits. Under the ACA, states were given a choice to participate in the expansion of their Medicaid benefits. On June 17, 2013; Governor Jan Brewer signed into law the AHCCCS Restoration Plan, to restore coverage to adults between 100-133% of the Federal Poverty Level, beginning January 1, 2014.

The Medicaid expansion will make approximately 300,000 additional poor and disabled residents eligible in Arizona. Many residents of Phoenix and Arizona who were not previously eligible for Medicaid through Arizona’s agency, Arizona Health Care Cost Containment System (AHCCCS), can reapply at www.healthearizonaplus.gov. If you are denied AHCCCS coverage for being over income, apply for health care coverage at www.healthcare.gov.

Low Cost Dental Clinics in Phoenix, AZ

In Phoenix, and the surrounding area of Maricopa County, low cost dental clinics are available. Be advised that waiting lists may be long. Visit www.WeAreOralHealth.org for a list of community dental clinics in Maricopa County.

For no cost oral health screenings for your children 0-5 years visit www.FirstTeethFirst.org for locations, days and times offered at Maricopa County WIC, immunization, childcare centers and various resource centers. For an interactive map, assistance and other helpful services in Phoenix. AZ; visit www.FindHelpPhx.org or dial 2-1-1.