As part of California’s implementation of the Affordable Care Act, individuals who buy medical insurance through new health plan exchanges will be required to buy pediatric dental benefits regardless of whether they have children. The new law will take effect on January 1, 2014. A similar law will take affect at that time in Washington State.
The Affordable Care Act law requires everyone to have health insurance or pay a penalty; however, it exempts dental benefits from this “individual mandate.” In contrast, the new law lists pediatric oral health services among the 10 “essential benefits” that health plans must include when sold to small groups, such as businesses with 50 or fewer employees, and to individuals. Furthermore, it allows dental plans to be sold separately from medical plans in state health insurance exchanges that the law provides for. In face of this contradictory provision, California and Washington have taken steps to extend the Affordable Care Act to include pediatric dentistry.
In addition to requiring families without children to buy a pediatric dental plan, it will also require single men to pay for maternity benefits. The concept behind the plan is that if everyone pays into the pool, regardless of need, it will spread risk among all individuals instead of just those who need the services.
The new policy will be enforced via features contained in the consumer Web site where enrollment in the small group market will take place. All the insurance plans sold through the exchanges will include essential benefits as one package; however, some may not have pediatric oral health services included. If the insurance purchaser selects health plans without pediatric dental benefits, the Web site will prompt the consumer to select a stand-alone pediatric dental plan and will not allow the consumer to complete the transaction without adding one.
To date, approximately half the states in the US have indicated they will not create their own health plan exchanges. For states that do not set up their own, the federal government will develop exchanges for any states that do not create their own. At present, it is unclear whether the federally run exchanges will also force consumers to purchase pediatric dental benefits. The Affordable Care Act does not contain a requirement that large groups, such as businesses with more than 50 employees, include pediatric oral health benefits, although many already offer such dental plans.
Take home message:
Insurance is basically a method of spreading risk; however, the question becomes “to what degree?” Laws such as the pediatric dentistry provision for California results in higher premiums to pay for services they never use. Most would agree that health insurance is necessary to safeguard against the financial impact of a major illness; however, many prefer to pay for dental services, which can be paid for at the time of nee rather than paying monthly for a dental plan.
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