The Patient Protection and Affordable Care Act went into full effect at the beginning of the year. The new law has changed the healthcare industry in many ways. One of the changes people haven’t heard much about is the impact on dental insurance. Here is an overview on the changes that you will need to be aware of.
Most Stand-alone Policies Are Not Effected
Data from the National Association of Dental Plans shows that about 98% of people have stand-alone dental plans. Most of these plans are not affected by the new ACA provisions. The only plans that need to change are those that didn’t previously offer pediatric dental care, which is now required under the law.
This means that most people do not need to worry about their dental plans being affected much. Smaller employees are unlikely to drop coverage, because premiums won’t change substantially either.
Limited Coverage Under Medicaid Expansion
Many states have chosen to expand Medicaid as required under the ACA. New Medicaid patients may receive some dental services. However, many of those services will be limited for patients living in states with limited Medicaid expansion.
For example, most Medi-cal (California’s version of Medicaid) patients in California will not receive dental care as part of the Medicaid expansion. For the most part, dental care is limited to youths under the age of 21. There will be some other exceptions though, so it is a good idea to check with the health exchanges or your state’s Medicaid office.
Implications of the Employer Mandate
The Affordable Care Act includes an employer mandate, which requires companies with over 50 full-time employees to provide healthcare benefits to them. Your employers will need to provide a healthcare plan that complies with all provisions of the ACA, including dental care.
Once the employer mandate goes into effect, your employer will be required to provide a plan that covers dental care. The employer mandate was extended until 2015, which means that you may not be guaranteed dental care from your employer until then.
Understand How Networks Operate
Every insurance company has a network of healthcare providers. You should find out whether or not your dentist is included in the network before getting your teeth fixed. Otherwise, you will face two problems:
- The services won’t be covered by your insurance company.
- The care that you receive won’t count towards your deductible or out of pocket cap.
Your insurer will tell you which providers are included in the network. If your existing dentist isn’t covered then you will want to look for a new one, unless you don’t mind paying for those services out of pocket.
Consult an Expert for Specific Plan Questions
Dental plans can vary significantly between different insurers. You will want to speak with an expert for more information on the benefits a plan provides. Your insurance provider, an ACA navigator and your dentist should all be able to help answer many of the questions that you have. Make sure that you ask them for help if needed.