Healthcare Law Requires Pediatric Dental Coverage
- By BSTQ Staff
Under the Affordable Care Act’s “10 essential health benefits,” individual and small group health plans sold under state-based health insurance exchanges and outside them on the private market will be required to cover pediatric dental services beginning in 2014. This requirement applies specifically to children who obtain coverage through private plans. However, large companies and plans that have grandfathered status under the law are not required to offer this coverage. Dental services already are included in the benefit package for children under Medicaid.
Specific coverage requirements will be determined by each state within guidelines set by the Department of Health and Human Services (HHS). The latest requirements by HHS suggest that medically necessary dental work may be required on top of preventive and restorative care. Under a private dental plan, preventive care is generally covered at 100 percent, but other services such as fillings, root canals and crowns require patients to pay up to half the cost, with coverage maxing out at about $1,500 per year. Under the ACA, pediatric dental coverage sold on the exchanges cannot have annual or lifetime limits on coverage. However, families who purchase dental health coverage on an exchange may be subject to an annual out-of-pocket cost-sharing charge. HHS recommends there be a reasonable annual limit. The National Association of Dental Plans suggests a limit of up to $1,000. The final rule, when issued, will clarify the amount.
