This is an excerpt from the April 2014 McGill Advisory Newsletter:
"Beginning in 2014, all Obamacare-approved health insurance policies sold on the exchanges, and in the small group (50or fewer full-time employees) and individual markets outside the exchanges, must include pediatric dental benefits for children through age 18. These pediatric dental benefits also include orthodontic coverage where "medically necessary," as defined by each state and/or insurance company. The PEW Center on the States estimates that 5.3 million additional children will gain dental coverage under Obamacare, although most of these will be added to public programs (Medicaid, CHIPs, etc.).
Traditional dental insurance offered through larger companies (over 50 employees) are not affected by this change, nor are children covered under Medicaid or CHIPs programs who will continue to receive existing benefits under those government programs.
Patients that are affected by the new rule can purchase the required pediatric dental coverage either under a separate dental policy, or as an "add-on" to their existing medical insurance policy. While the services covered are typically the same under either option, the out-of-pocket cost to the patient can vary tremendously.
Standalone dental policies are subject to Obamacare's specific actuarial requirements that keep copayments and deductibles low. In addition, the deductible is usually not applied to preventative and diagnostic procedures, so that periodic office visits, cleanings, X-rays, and sealants usually cost the patient nothing out-of-pocket. However, the premiums for these standalone dental policies will usually be higher than the premium increase in the medical plan resulting solely from adding pediatric dental benefits to it. The higher premiums involved in standalone policies, combined with the hassles of maintaining two separate policies, will likely push the vast majority of patients into obtaining the required pediatric dental coverage through their existing health insurance policy.
Deductibles under Obamacare-approved medical insurance policies sold on the exchanges can be up to $2,000 (one person covered) or $4,000 (more than one person covered) annually, with a typical range of $1,500-$3,500. Moreover, the maximum out-of-pocket cost (including deductible, copayments, and coinsurance) is $6,350 per year for individual coverage and $12,700 per year for family coverage.
Handling patients who have pediatric dental benefits embedded in their medical policy will present unique challenges for dentists. First, coding procedures will be significantly different and more complex. More importantly, those familiar with traditional dental insurance may perceive that their medical insurance policy will cover most or all of the cost of pediatric dental care while in reality, most, if not all, of the payment for services rendered will come out of their pockets, due to the high deductibles and out-of-pocket maximums involved.
Today, only 30-40% of patients with medical insurance policies actually meet their annual deductible. With deductibles increasing under Obamacare-approved policies, this percentage will likely drop further in the future. The growing number of patients that don't meet their deductibles will be paying most, if not all, of the cost of their children's dental care right out of their pocket!"
Most people don't think Obamacare will affect their dental insurance, but this article proves otherwise. Please be careful in choosing your insurance plans!
