Why Some ACA Exchanges Have Delayed Adult Dental Coverage

The American Dental Association has estimated that three million children will gain dental benefits through the Affordable Care Act’s health insurance exchanges by 2018, compared with just 800,000 adults. The difference seems jarring, until one examines the ACA’s fine print.

Under the ACA, pediatric dental coverage is considered an essential health benefit that must be included in qualified health plans sold through the exchanges. Such benefits can be offered through stand-alone dental plans or a health plan with embedded dental benefits. In addition, pediatric dental coverage can be sold as a child-only plan or as a family plan.

Adult dental coverage is not considered an essential health benefit under the law, leaving the decision of whether to offer adult coverage up to the exchanges.

Jonathan Shenkin, vice president of the American Dental Association, in an interview with Pew Charitable Trusts’ “Stateline,” described the law’s approach to adult dental coverage as “a big flop.”

Advocates Tout Dental Coverage Benefits

Dental care providers and advocates have long lobbied to increase access to dental coverage, noting the health and economic benefits associated with good oral care.

In Phoenix Business Journal opinion piece, Tiffany Di Giacinto, director of marketing and communications for Delta Dental of Arizona, noted that “dental coverage is relatively low cost” and “encourages preventive checkups that can help prevent bigger problems.”

Ariane Terlet, chief dental officer at La Clinica de La Raza, said, “[R]esearch shows an association between gum disease and diabetes, cardiovascular disease and stroke.” She also noted that good oral health can reduce the cost of providing medical care, citing research that found patients receiving regular dental care had faster recovery rates after heart surgery than those who were not.

The State of Exchange Dental Plans

The law’s flexibility on adult dental coverage means that health insurance exchanges have taken different approaches to adult dental coverage, resulting in disparate coverage options.

A research brief from the American Dental Association’s Health Policy Institute looked at health insurance exchanges in 40 states and found that 35.7% of the health plans offered in 2015 included embedded pediatric or family dental benefits, compared with 26.8% in 2014.

The researchers also found that the quality of information has improved in the federal exchange. In 2015, the website clearly stated whether a medical plan included pediatric and/or adult dental benefits and the amount of cost-sharing associated with those services. During the previous open enrollment period, individuals had to call each plan to learn which dental services were covered and at what cost.

Exchanges offering adult dental out the gate

The federal exchange offers both stand-alone and embedded dental coverage for adults, children and families.

Several state-run exchanges — including those operating in Colorado, Minnesota, New York and Oregon — also began offering adult dental benefits during the first open enrollment period. Oregon has since closed its state-run exchange and now offers coverage through HealthCare.gov. 

Joe Metlen, communications and legislative manager for the Oregon Health Insurance Marketplace, in an email to California Healthline said that Cover Oregon opted to sell adult dental coverage because the exchange believed it “was an essential part of health care.”

Luke Clark, director of communications for Connect for Health Colorado, told California Healthline, “The value of good oral health to overall wellness is critical to our role and mission.” He added, “Medical, dental and vision benefits are considered the expected norm from consumers” and the exchange is committed to meeting their needs.

Exchanges that delayed offering adult dental coverage

However, some exchanges delayed offering adult dental coverage. Covered California and Your Health Idaho both are offering adult dental coverage for the first time during this year’s open enrollment period. Covered California spokesperson James Scullary said the exchange’s focus during the first open enrollment period was “to increase the number of insured Californians.” The exchange successfully enrolled more than three million California residents during that time period.

In August 2014, the exchange announced plans to offer adult dental coverage in the second open enrollment period. Scullary noted that Covered California “wanted to offer adult dental benefits to help our consumers,” citing a strong connection between individuals’ oral health and overall health. However, the exchange faced technical challenges in implementing the necessary changes in its enrollment system and was forced to postpone the coverage.

Earlier this month, Covered California officials announced that about 33,000 adults had signed up for the new dental plans — a figure Scullary said has “surpassed our expectations.”

Your Health Idaho, which used federal technology during the first open enrollment period, relied on lessons learned from other states as it prepared to launch its own system for the 2015 open enrollment period, according Pat Kelly, executive director of Your Health Idaho.

Kelly told California Healthline that adult dental care “was always on our roadmap and always planned to have it,” but the exchange decided to “minimize scope for only absolutely critical functionality,” which is why adult dental care was not included.

The Washington Health Benefit Exchange is now the only health insurance exchange that does not offer a form of adult dental coverage. Michael Marchland, director of communications and outreach at the Washington Health Benefit Exchange, said that the exchange for the first two open enrollment periods focused on creating and maintaining “a fully operational and functioning marketplace that would offer health plans in accordance with the ACA.” As such, the exchange was precluded from “adding in new offerings and functionality, including adult dental.”

However, he said the exchange’s board in February 2015 approved a decision to add adult dental coverage to the marketplace, which the exchange expects will be ready to launch this summer.

The implementation of adult dental coverage in the Washington Health Benefit Exchange will mean that adults in all 50 states and Washington, D.C., will have access to those benefits through the ACA exchanges and dental disparities could be reduced.

Around the Nation

Diagnoses on the rise. A recent study published in the Journal of the American Medical Association finds an association between an increase in the number of women under age 26 receiving early-stage cervical cancer diagnoses and an Affordable Care Act provision that took effect in 2010, the New York Times reports.

On the campaign trail. According to Modern Healthcare, former Maryland Gov. Martin O’Malley, a Democratic presidential candidate, has released a plan to reform health care that would repeal the Affordable Care Act’s “Cadillac tax.”

Related Topics

Covered California Road to Reform The Health Law