How does the Affordable Care Act Affect Dental Care?

You’ve probably heard a lot in the news about something called the Affordable Care Act, also known as Obamacare. What is the Affordable Care Act and how does it affect you and your children’s dental care? How does it affect people who are on Medicaid? Read on to find out.

What is the Affordable Care Act?

The Affordable Care Act (ACA for short) is a law that will make it easier and more affordable for many Americans to buy health insurance, starting January 1st, 2014. Some of the most important changes that will come about as a result of the ACA are:

  • Everyone has to have health insurance: Beginning January of 2014, all U.S. citizens are required to have health insurance. It is the law. If you do not purchase some kind of insurance by March 31st, 2014, you will have to pay a penalty, which is $95 or 1% of your income, whichever is greater. By 2016, the penalty will go up to 2.5% of your income.
  • No one can be turned down: No one can be denied or made to pay more for health insurance because they have certain health conditions (like asthma) or because of their gender (women have had to pay more for their health insurance in the past).
  • Before the ACA, there were three ways to get health insurance:

○      through your employer

○      directly from a private insurance company

○      from the government (Medicare or Medicaid)

  • After the ACA, there are now four ways to get health insurance:

In addition to the three ways listed above, there is now a fourth way to get health insurance, and it is through something called a “health care marketplace” (also known as a “healthcare exchange”). This marketplace can be found at  www.healthcare.gov. A health care marketplace is an online store where you can choose from many different health insurance plans from many different private companies. The idea is that because these private insurance companies are all competing for your business, it keeps prices down and more affordable for you, the buyer. Also, because you can go to one website, run by the government, and compare many different plans, it makes it easier and less confusing to buy health insurance. There are many health insurance providers who aren’t part of the healthcare marketplace, but you can still buy insurance from them. You would just have to contact them directly by calling them or going to their website.

  • You get tax credits if you have a low income: If you buy insurance through the marketplace at healthcare.gov, and your yearly income is less than 400% of the Federal Poverty Level, you can get a tax credit. To see Federal Poverty Level guidelines for 2014, go here. The lower your income, the bigger your tax credit. For people with higher incomes, they will not get tax credits, so it might make more sense for them to buy outside of the healthcare marketplace, directly from a private insurance company.
  • Children will be able to stay on their parent’s health insurance plans until age 26.
  • Essential Health Benefits: If you’re getting insurance from the healthcare marketplace or directly from a private insurance company (but not through an employer), they must cover at least 60% of the cost of 10 things, known as the 10 Essential Health Benefits. These Essential Health Benefits (EHBs) include things such as emergency services, hospital visits, and pediatric services (including oral and vision care). Pediatric, as it relates to the EHBs, means under the age of 19.

How does the ACA change Medicaid?

One important change that comes with the Affordable Care Act is that many states will be participating in something called Medicaid expansion. In the past, your income had to be at or below the Federal Poverty Level in order to make you eligible for Medicaid. Now it can be at 133%. Also, in the past, you had to be part of a group, such as elderly, disabled, pregnant, or a parent. Now any adult in states participating in Medicaid expansion can receive Medicaid if they meet the income requirements. However, as many as 22 states are choosing not to participate in Medicaid expansion. To find out if you qualify for Medicaid, or if your state is expanding Medicaid, go here.

How will the Affordable Care Act affect my dental care if I’m not on Medicaid?

  • If you work for a company with over 50 employees, and you receive dental care through your employer, your dental coverage will not change. Although with the ACA, employers for large groups (ever 50 employees) are not required to provide dental coverage for adults or children, employers for large groups provide dental coverage more often than not.
  • All health insurance plans for individuals or small groups (companies with fewer than 50 employees), whether purchased within the healthcare marketplace or outside of it, are required to provide dental coverage for children up to age 19 (or age 21 in some states). Within the marketplace, this pediatric dental coverage can be combined with a medical plan, or it can be stand alone. It depends upon the state. If it is stand-alone, parents are not required to purchase it.
  • If health insurance is bought outside of the marketplace, pediatric dental coverage must be included in the plan, not as a stand-alone benefit.
  • Pediatric dental benefits usually cover 100% of preventative services like exams, cleanings, and sealants. But they will most likely only cover half the cost of services such as fillings, crowns, and root canals. The good news is that all insurance plans will now have something called an “out-of-pocket maximum” for pediatric dental care, which means you won’t have to spend more than, say, $750 per year. This does not include your monthly premium costs. There are also no lifetime or yearly limits on how much dental care your children can receive.
  • Not all childrens dental care will be covered by the new law. For example, only orthodontic treatments that are medically necessary (such as a cleft palate) will be covered.
  • Health insurance plans bought inside or outside of the marketplace are not required to include dental coverage for adults. This means that if you do not have a health plan that includes adult dental coverage, you may have to purchase a stand-alone dental benefit for yourself that is different from your child’s dental benefit. It is estimated by the National Association of Dental Plans that this could lead 10 million adults not having dental coverage.

Why is dental care important?

According to the U.S. Centers for Disease Control and Prevention, dental cavities are the most common chronic disease of children and adolescents, ages 6 to 19 years. Untreated cavities can cause kids to experience chronic pain and discomfort that can affect sleep, confidence, and even school performance. Your oral health is also tied to your overall health. Gum disease has been shown to increase risk of heart disease, dementia, and diabetes. If your mouth is not healthy, you are not healthy.

 

There are many differences in the law, depending on which state you live in, that are not covered in this article. Visit www.healthcare.gov to apply for health insurance and see what options are available for you and your children.

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