March 2013 Dental Care Coverage under the Affordable Care Act

Tooth decay is the most common chronic health problem in children. By the time many enter Kindergarten, more than a quarter of children have decay in their baby teeth. The problem worsens with age, and nearly 68% of populations in ages of 16-19 have decay in their permanent teeth according to Centers for Disease Control and Prevention.

Starting in 2014, the Affordable Care Act requires that health plans (individual and small group plans) include pediatric dental services. However, plans that have grandfathered status under the law are not required to offer this coverage. The changes in the health law apply specifically to children who get coverage through private plans. Dental services are already part of the benefit package for children covered by Medicaid, the state-federal health program. But many eligible kids are not enrolled, and if they are, parents run into hurdles finding dentists willing to accept Medicaid payments. The health law encourages states to expand Medicaid coverage for adults, which advocates way will have the added benefit of probably bringing more children into the system.

Dental health advocates are pleased that pediatric dental services are included in the 10 essential health benefits, which new health plans must cover. Experts say that poor oral health care can have significant impact on overall health, causing pain, weight loss, missed school days and reduced self – esteem.

Department of Health and Human Services (HHS) suggest that medically necessary orthodontia-to correct a problem with chewing for example- may be required in addition to preventive and restorative care. HHS and dental insurance providers are working together to clarify cost of out of pocket costs will be, as a reasonable limit of $1,000 - $1,500.00. This would primarily cover orthodontia as other expenses would be covered under dental plans. This would increase the premium from $25.00 to $34.00 monthly.

Dr. John Bush our school dentist will be providing dental screenings on Monday March 18 th , for only those who have not listed a dentist in grades K-6.