Friday, January 24, 2014

Q and A: Must all medical plans have pediatric dental under the new rules of Obamacare?

Each state has been given significant leeway on this particular matter.

In Utah, for example, insurers on the state’s exchange have to cover dental cleanings and sealants for children, but they don’t have to pay for any restoration, such as fillings for cavities.

California passed state legislation in 2012 requiring all non-grandfathered medical plans sold to individuals and small employers (but not large groups of 50 or more), to include coverage for all ten essential health benefits, including pediatric dental coverage.*

But, most medical plans sold and created for the Exchanges did not have dental benefits in them. So many states had to graft them in after the fact via separate dental providers. States that did this do not have to require parents to purchase them. While some states, such as Washington and Nevada, are making it a requirement, others are not. So in effect, although pediatric dental benefits are deemed essential by Obamacare, they will not be mandatory in all states.

In states that are meeting this requirement by providing stand alone dental plans (as opposed to having the benefit baked into a medical plan) federal subsidies are not available for premium assistance even though those subsidies are available when the dental is part of a medical plan.

* CA Health and Safety Code (HSC) §1367.005 and CA Insurance Code (CIC) §10112.27 (AB 1453, Chapter 854, Statutes of 2012 and SB 951, Chapter 866, Statutes of 2012 respectively.)

Additional information available here and here.