California's health insurance exchange, Covered California, will require pediatric dental coverage in all medical plans starting in 2015, after their board voted last week to require this coverage for all pediatric medical plans sold through the marketplace.
At present, Covered California offers five standalone dental plans, plus a bundled plan. However, new data showed that less than a third of the children enrolled in Covered California through 2013 also had dental coverage, according to a kqed.org story. The added cost of dental coverage appears to be a decisive factor in the low number of enrollees, officials said.
Pediatric dental coverage is one of the Patient Protection and Affordable Care Act's 10 essential health benefits, but the law gives states the flexibility to offer the coverage in standalone plans. Along with the five standalone pediatric dental plans, Covered California also offers what's called a "bundled" plan in which insurers pair a standalone dental plan with a medical plan. Critics have argued the exchange should also offer so-called "embedded" pediatric dental plans that are included in medical plans.
Covered California initially required insurers to include pediatric coverage, then told them to strip out the benefit, in favor of offering standalone plans at an additional cost.
The Children's Partnership advocacy group hailed the change, citing how dental disease can severely impact children's ability to eat and can cause them to miss school.
But some insurers disagreed with the board's decision. Delta Dental said the change will encourage medical insurers to partner with less expensive HMO dental plans that may have a limited number of providers.
Officials with the Children's Partnership agreed that availability of providers is an issue and said the state's Medicaid program, Medi-Cal, should work to ensure that coverage networks are adequate and that families have access to dentists in their communities.
Covered California said it may let people buy extra dental coverage if they want to keep their current dentist.
