Many Americans have questions about how dental care is affected by the Affordable Care Act (ACA), also known as ObamaCare. Overall, dental care is available to more Americans for two reasons: 1) pediatric dental care is considered an essential benefit for plans sold in the Marketplace and for all individual and small group plans outside the Marketplace, and 2) dental benefits are already required in Medicaid. With many states expanding Medicaid eligibility, this will extend additional dental benefits to more lower-income Americans.
Adult and Pediatric Dental Care
While pediatric dental care is considered an essential health benefit under the ACA, adult dental care is not. This means that health insurance plans do not have to offer dental coverage to Americans 18 and over, although they may choose to do so. Stand-alone dental plans are available in the Marketplace, allowing citizens to purchase dental insurance if they are not covered under their normal insurance plan.
But there is no requirement that consumers purchase those pediatric dental benefits if they are offered as part of a stand-alone dental plan and not as part of a medical plan.
One essential health benefit included in the essential health coverage is pediatric dental care. Pediatric dental care includes preventive oral health assessments for young children as well as regular dental care through age 18. Employer-sponsored plans are not required to offer pediatric dental benefits because only plans purchased inside the Marketplace or individual or small-group plans purchased outside the Marketplace are required to provide these benefits, but a Marketplace stand-alone plan can be purchased for a child.
With the exception of a few states like Nevada and Washington, parents are not required to purchase dental insurance for their children if they do not wish to do so. The law simply states that pediatric dental coverage must be available to parents, but keep in mind federal tax credits are not available if the plans are stand-alone.
Dental Care in Medicaid
Dental care was included in Medicaid coverage before the ACA, and in many states the Medicaid eligibility standards are being expanded. While this means that new groups of lower-income Americans will be have access dental coverage, this is not a guarantee of access to care because dentists who take Medicaid are often hard to find..
In many states, even though a parent may not qualify for Medicaid, their children can still qualify for the Children’s Health Insurance Program (CHIP). CHIP provides children from lower-income families a variety of health benefits, including dental and vision care. The actual dental care covered may vary by state, parents should be sure to check with their state office for more information.
Dental Care Without Insurance
The ACA doesn’t just offer new insurance options; it also provides funding to community health centers so they can offer additional services to lower-income Americans. This care is priced on a discounted or sliding scale. For Americans who obtain a waiver to avoid paying the individual mandate penalty, as well as those who possess health insurance, there may be community medical centers that offer dental care. For more information, contact a community health center near you.
The ACA has opened doors for more Americans to access insurance coverage for dental care. Whether you choose a plan that includes dental coverage or purchase a stand-alone dental plan, taking care of your dental health is an important part of living a healthy life.