Orthodontics is one area of dentistry that could be affected by the Patient Protection and Affordable Care Act (PPACA), according to Evelyn Ireland, executive director at the National Association of Dental Plans.
The extent to which orthodontic services will be covered depends on whether a service is classified as cosmetic or medically necessary, she noted in a news story in Employee Benefit News.
"Orthodontia is one of the big coverage differences that [may] occur for pediatric dental," Ireland said. "Pediatric dental in the proposed rules is defined as any enrollee up to [age] 19. So, the way [the PPACA] is structured, pediatric dental is a benefit that is described as part of the essential health benefits that will be offered in the small group and individual market. Of course, the small group market includes exchanges."
Since orthodontia is not preventive care and does not get much largesse from PPACA, only about 30% of braces, head gear, and mouthguards would qualify for financial assistance, she added, noting that roughly one-third of children between birth and 20 who get orthodontic treatment will be covered while the rest will not.
