Covered California, one of the largest state-run insurance exchanges in the U.S., will offer new family dental plans to consumers who enroll in health insurance coverage in 2015. All individual health insurance plans sold through the exchange will include pediatric dental benefits for those younger than 19.
Among the most significant changes to benefits next year: Parents will be eligible for federal subsidies to make coverage more affordable, and pediatric dental benefits will be included in all health plans.
Exchange officials decided to require pediatric dental coverage in all medical plans after data showed that less than a third of the children enrolled in the exchange also had dental coverage in 2013. The added cost of dental coverage appeared to be a decisive factor in the low number of enrollees, officials said.
Pediatric dental coverage embedded with Covered California's health insurance plans. All images courtesy of Covered California."This ensures that children have the right to basic dental care," Anthony Wright, executive director of Health Access California, told DrBicuspid.com. "It also ensures that families have the option of getting dental coverage through their health insurance."
"That's one of the first questions I get when I speak about Obamacare to general audiences," he added. "People ask, 'Does it include dental?' "
Colin Reusch, policy analyst at the Children's Dental Health Project, agreed that embedding pediatric dental will improve children's access to dental care.
"Including pediatric dental in all the health plans ensures that every child and adolescent enrolling in coverage through Covered California has a comprehensive dental benefit," he told DrBicuspid.com. "In addition, it guarantees that qualifying families receive a tax credit based on the full cost of their coverage, which often isn't the case when children's dental coverage is purchased separately."
"It's also worth noting that Covered California has structured their standard plan designs so that pediatric dental services are not subject to the medical deductible as is sometimes the case when dental coverage embedded in a health plan," Reusch added. "This decision makes necessary oral healthcare much more accessible for children without breaking the bank for families and places California alongside Connecticut as a model for how to integrate children's dental benefits into marketplace coverage."
Pediatric dental coverage is one of the Patient Protection and Affordable Care Act's (ACA) 10 essential health benefits. But since it is now offered as standalone insurance, parents weren't picking it up because it was outside of their medical plan and they weren't getting the federal subsidy, according to Wright.
"We thought that was a real problem," he said.
Embedding pediatric dental coverage in all health plans also makes it affordable, Wright noted.
"If we spread the risk and cost of pediatric dental coverage among the whole population, then the actual per-person cost for making pediatric dental an essential benefit -- as the ACA mandates -- is very minimal. So we thought that was the best solution," he explained. "And for those families who want to make sure they have dental coverage, there is the option to add that to the health insurance that they're purchasing. We think that's also a good choice."
Conrado Bárzaga, MD, executive director of California's Center for Oral Health, also noted that importance of parents qualifying for subsidies when pediatric coverage becomes embedded in all health insurance plans next year.
He expressed "cautious optimism" until the plans' features are revealed.
"Details of the requirements have not been announced yet, especially what will be covered under these expanded new plans," Dr. Bárzaga told DrBicuspid.com.
The California Dental Association (CDA) also applauded the changes.
"The embedding of children's dental benefits in health plans in Covered California's individual market ensures all kids in that market will have coverage and allows for a federal subsidy that may help qualified parents obtain insurance, but most health plans have never offered dental benefits," the group stated in an email to DrBicuspid.com.
The CDA echoed the concerns of other advocacy groups that worry if there will be enough dentist providers who will be included in the plans.
"The CDA is asking Covered California and state regulators to closely monitor insurance companies' dental offerings and patient experiences to ensure the plans meet the needs of policyholders and maintain a robust network of dental providers able to provide timely access to care," the group wrote.
Premiums for Covered California will go up an average of 4.2% in 2015 for the 1.4 million Californians now enrolled in the exchange.
Some 90% of consumers currently enrolled in health insurance plans through the exchange are receiving federal subsidies to help reduce their overall costs. In most areas of the state, the amount of subsidy that individuals receive will either increase or remain very close to 2014 subsidy amounts, officials said. This means that for many consumers, any increase in premium will be offset by an increase in subsidy.
Covered California executive director Peter V. Lee said in a statement: "This is great news for families and children, because all children enrolled in Covered California will have dental coverage embedded in their comprehensive health plan. They will be getting better coverage and more for their money."
Family dental plans are offered from these companies.Additionally, Lee said, the family dental plan will offer adults the option of receiving dental coverage outside the general health plans at an additional cost. Some consumers also may be drawn to family dental plans if a provider they prefer for their child is not offered in their embedded coverage.
"The CDA is pleased about the addition of family dental plans in 2015 that will allow adults to purchase dental insurance through Covered California, which was not an option until now," the group told DrBicuspid.com. "Offering coverage by both dental plans and health plans helps to ensure families can choose the dentist and dental coverage that works best for them."
The optional standalone family dental plans, which offer coverage for adults, will not be available at the beginning of open enrollment, which starts November 15, but are planned to be added in early 2015. Covered California will offer both dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans, giving consumers a choice in the type of plan that will work best for them. There is no financial assistance available for the optional adult dental benefits.
Dr. Bárzaga also pointed out the disconnect between the start of open enrollment and enrollment for standalone adult dental coverage. "This is going to create confusion and ultimately may prevent some families from taking advantage of this opportunity and having the dental coverage they need," he noted.
Lee emphasized that there is no requirement to enroll children in a family dental plan. The family dental plan is optional and is primarily intended to offer affordable dental coverage to adults that was not available in 2014. Families should remember that adding their children to a family dental plan will result in an extra cost for the same dental services they already receive in their standard health insurance plan.
Covered California is notifying enrollees to explain the availability of pediatric dental benefits in its health insurance plans, as well as to explain the newly available family dental plans that include dental benefits for adults.
Price ranges for the extended coverage plans can be found on the Covered California Health Plans page. Covered California has launched its Shop and Compare Tool for people who want to look at plans and products in their area, and also get a preliminary estimate of costs and premium assistance.
A booklet containing more information about the new family dental plans is available online on the Covered California website.
