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How the ACA Affects Your Dental Health


The Affordable Care Act's affect on dental coverage for you and your family.

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The Affordable Care Act (ACA), passed in 2010, made sweeping changes to health insurance and, ultimately, other types of coverage such as dental insurance.

However, even though a significant amount of time has passed since the ACA became law, it may be difficult to keep up with how these changes affect you and your family. For instance, ACA required that companies with more than 50 full-time employees are required to offer a health insurance plan or else pay a fine1, and insurance plans can no longer ban the coverage of pre-existing conditions whereas before the ACA, this was legal.

The ACA also made some changes that may affect your dental insurance options as well. Dental coverage for children was considered an essential health benefit2 under the law. However, research from the Health Policy Institute has shown that lack of coverage in the past decade under ACA has declined 6 percentage points3. While it might be hard to directly correlate the ACA with more people gaining dental insurance, the increased enrollment in dental plans is a positive outcome for overall health across age groups.


Each state varies in how they’ve expanded dental insurance coverage under the ACA; however, the state where you live may have specific changes that could affect you. It is important to understand the general changes to health coverage under ACA and how they might impact your dental insurance plan. 

Expanded Dental Benefits to Employees

More than half of Americans4 receive dental coverage through their employer, and this includes nearly two-thirds of adult workers who do not yet qualify for Medicaid because they are too young to meet its age requirements.

However, you may benefit from one of the two cost-reductions that the ACA has brought to employer-sponsored dental plans.

Some employer-sponsored dental plans have lower out-of-pocket expenses after the ACA was rolled out nationwide. Also, some dental plans offer free semi-annual preventive treatments. This means you’ll be paying less for regular checkups and yearly dentist visits.

Employees can take advantage of their employer-sponsored dental insurance and see lower costs than if they tried to visit the dentist without insurance. Plus, preventive treatments are helpful in many ways such as making sure there are no major dental problems and checking for progress on any ongoing issues. Your dentist can keep track of concerns they may have following your last checkup and make sure you are following a good oral care routine. 

Dental Benefits for the Healthcare Marketplace

Not everyone enrolls in health insurance through their employer for a wide variety of reasons, such as if their employer does not have a large enough workforce to justify having the benefit available to employees. However, the healthcare marketplace exchange can be a way for workers to enroll in health insurance, including dental insurance, to keep costs lower than if they did not have health insurance at all. 

You can only buy health insurance through the marketplace exchange if you are purchasing a health plan at the same time. However, there are two options available for accessing dental coverage5 in this way: 

  1. Plans with dental coverage built into them
  2. Stand-alone dental insurance plans

Available plans on the marketplace may have higher premiums but lower copayments and deductibles, or they may have lower premiums but higher copayments and deductibles. Be sure to carefully read about the options available to you to choose a plan that best fits your needs. 

Expanded Dental Benefits to Children

If you’ve got dental insurance, you’re more likely to have better oral health. Access to preventive care, such as dental cleanings, can make dental insurance worth it to parents who want their children to have health teeth for life. Plus, dental insurance may be more affordable than emergency dental care in the end because Americans pay about $360 a year, or between $15 and $50 a month6 on average for dental insurance, whereas an emergency dental need like surgery could be more than $1000.

If the cost of dental insurance for your child is hard to swallow, consider this: your child may be eligible for dental coverage under the Children’s Health Insurance Program (CHIP)7 if your state has participated in Medicaid expansion.

This Medicaid expansion program allows eligible children under 21 years of age to receive dental coverage that can help: 

  • Prevent oral disease
  • Support restorative procedures
  • Treat dental emergencies
  • Promote overall oral health 

The ACA makes it possible for children in low-income families to improve their oral health. It is estimated that 38.5 percent of children ages 2-18 have dental benefits through Medicaid or CHIP8

 

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Expanded Dental Benefits for Adults in Medicaid

Under the ACA, Medicaid expanded its services to more low-income adults in many different sectors which included dental in some states.

Around 34% of Americans are covered by Medicare and Medicaid.9 Of the 37 states that adopted expanded coverage for Medicaid recipients, 34 states and the District of Columbia  have at least some dental benefits available to adults who qualify for Medicaid. 

Some states cover dental services through managed care organizations or may be limited by state-set maximums on per-person spending for dental benefits, or on the number of dental services each person is allowed annually.

Although more low-income adults have access to dental benefits through Medicaid under the ACA, Medicaid beneficiaries may face high out-of-pocket costs for dental care, which can still make it hard to afford. Private dental insurance may be the key to finding the plan you need at the price you can afford. 

Why Private Dental Insurance May Be an Option for You

Between not qualifying for Medicaid, not having an employer-sponsored dental plan, or finding your employer-sponsored plan too expensive, there are several reasons why you may want to shop for an individual dental insurance plan on a healthcare exchange like what the ACA provides. If private dental insurance is an option you are considering, it is important to keep the following in mind: 

  • Types of plans available - Choose between a Dental Health Maintenance Organization (DHMO) plan, a Dental Preferred Provider Organization (DPPO) plan, or Dental Indemnity Insurance for what makes the most sense for your healthcare budget.
  • Preventive care benefits - Most insurance plans cover preventive care, which is helpful to consider when you know that almost half of adults ages 20-400 have untreated tooth decay.10
  • Coverage when you need it - The cost of problems such as root canals can be substantial if you have no dental coverage. The cost of dental insurance may be worth it if you encounter the unexpected, such as emergency surgery. 

Sources:

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.
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