Dental coverage under Obamacare; comprehensive, unlimited and affordable … Here we go again

You pay, no you pay.

You pay, no you pay.

There is a reason why dental insurance through employer plans is often limited to some extent; to keep it affordable and in recognition that dental care unlike medical is more often a manageable expense, one that can be planned for. In addition, there are instant benefits from low-cost preventive care. Dental expenses are ideal for a flexible spending account (FSA). Unfortunately, the $2,500 limit on FSA contributions under the Affordable Care Act greatly reduces the FSAs value in paying for such things a braces… so instead policymakers expand coverage in exchanges, increase premiums and the government subsidy in the process.

None of that matters under Obamacare. Dental care must be comprehensive and unlimited for children…defined as to age nineteen. Dental benefits are part of essential health benefits for small groups and insurance offered through the exchanges come January 2014. These required dental services will add significantly to premiums. For example, read this excerpt from Kaiser Health News:

Milliman estimated that premiums currently range from $21 to $25 per child per month, depending on whether a plan covers orthodontia services, among other things. After incorporating the health law’s requirements, Milliman projected that premiums would probably rise to $34 a month, Ireland says.

Are we never going to learn our lesson? Rather than take a strategic, targeted approach, we rush headlong into more and more of whatever is the cause of the moment. Unlimited dental coverage, including “medically necessary” orthodontics is an open invitation for abuse and over utilization. If you are receiving insurance through an exchange and your premiums and even your out-of-pocket costs are being subsidized, how much will you care what services are rendered or how much they cost, especially services that are “free.” Does anyone think that all braces for children will not now be “medically necessary?” We are transferring the same problems we have with health care coverage to dental care. We are making the same mistake of encouraging the mindset that our personal responsibility is not needed. We are again assuming that if someone else is not paying, it is not affordable. Check the quote below. Is the problem that braces cost $6,500 or that your insurance does not pay more?

Here is more from the Kaiser article:

Under the health-care law, pediatric dental health coverage sold on the exchanges cannot have annual or lifetime limits on coverage.

But families who buy dental coverage on an exchange may be subject to an annual out-of-pocket cost-sharing limit of up to $1,000 for dental care. A rule proposed by HHS suggests there be a “reasonable” annual limit. The National Association of Dental Plans has proposed $1,000. Experts expect that the final rule, when issued, will clarify the amount.

“That would be on top of whatever out-of-pocket limit people are already facing [for medical coverage],” says Colin Reusch, senior policy analyst at the Children’s Dental Health Project, who co-authored a recent report on the health law’s pediatric dental benefit. “We see that as being in conflict with what the law intends.”

Evelyn Ireland, executive director of the National Association of Dental Plans, says families who need expensive dental care such as braces may fare better in dental plans sold on the exchanges than in the plans many employers currently offer.

Nationwide, medically necessary orthodontia costs roughly $6,500 per person, Ireland says. Currently, if a private dental plan covers orthodontia, the benefit typically covers 50 percent of the cost, up to a lifetime limit of $1,000 or $1,500. “So it ends up basically being a down payment,” she says.

Assuming braces are a covered benefit, the family of a child with dental coverage through an exchange might have to pay the maximum out-of-pocket limit — $1,000, perhaps — and owe nothing more that year for the child’s dental care. But any other expenses would be covered, since plans can’t have dollar limits on coverage.

That unlimited coverage will probably add to the premium for pediatric dental coverage, however.

Will “probably” add to the premium? da ya think?


2 replies »

  1. Does everyone in the insurance industry and dental industry feel that we older people are just not worth a damn anymore, especially, once we retire?. I need surgery in my mouth because of bone buildup(tori), and pain; however, the EFFING insurance industry looks at this as dental procedures, which they refuse to cover. Even though the procedure is done by a surgeon(MD). BULLSHIT! We are on fixed incomes! It’s a MEDICAL procedure. Why is it NOT covered by insurance companies as medical??????????


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