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For People With Bad Teeth, Plan Coverage May Have Cavities

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The new federal Affordable Care Act may not do much to help adult Americans pay for restorative dental care.

ACA–the legislative package that includes the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act–is supposed to make more dental benefits available for children who receive subsidized health coverage through a health insurance exchange, and it will expand government efforts to assess the state of U.S. residents’ oral health.

The secretary of Health and Human Services could put some dental benefits on the list of preventive services benefits plans that are sold through the health insurance exchange system.

But ACA imposes no direct requirements on either individual or group plans to provide dental benefits for adults.

ACA will let uninsured individuals and small employer groups buy medical insurance through the health insurance exchanges, and it will create an option for employees of companies with especially expensive medical benefits to buy exchange coverage.

One possible result: The number of U.S. residents with limited-benefit dental coverage could skyrocket, according to Marc Pierce, president of Stonegate Strategic Advisors L.L.C., Chicago, a consulting firm that advises life and health insurers on health and wellness issues.

Large and midsize employers probably will continue to offer comprehensive dental coverage, because “their employees are expecting it,” Pierce says.

Even “young invincibles” who think they will live forever, with perfect teeth, may be willing to pay $5 to $20 per month for a preventive-services-only plan that covers two exams, two cleanings and a set of X-rays each year, Pierce says.

When the marketers who developed the young invincibles health insurance program at WellPoint Inc., Indianapolis, were conducting consumer surveys, they found that young participants “couldn’t understand why their teeth weren’t considered to be part of the body,” Pierce says.

Health insurers may see offering free or inexpensive dental preventive services coverage as a good way to set themselves apart from competitors, Pierce says.

But Pierce predicts that typical health insurance exchange customers will choose lower monthly premiums over richer benefits.

A plan that provides more than $1,000 in annual coverage for fillings, crowns, periodontal services and other services would cost twice as much as a preventive-services-only plan, Pierce estimates

A “buy-up” dental market could appear, but the products sold through that market might look different from the comprehensive dental coverage sold today, Pierce says.

Rather than emphasizing coverage for conditions such as gum disease, the buy-up products might emphasize discounts and financing for consumers who need cosmetic dental services, Pierce says.

A Web search for the term “dental care financing” already turns up about 200,000 hits.

Dr. Juan Pablo Eng, the founder and owner of DentiCenter, Tijuana, Mexico, is expecting ACA to increase the popularity of another strategy for coping with dental coverage gaps: Dental tourism.

DentiCenter, one of many “Mexican dental vacation” providers, runs several dental offices in Mexico, and about 95% of the patients are U.S. residents who need a great deal of restorative work and are trying to hold down the cost, Eng says.

Eng has worked to get the offices into U.S. dental insurance provider networks, and they are now in networks run by Aetna Inc., Hartford, and the Delta Dental plans. The offices also serve large, self-insured employer plans and individual patients who seek out Mexican dental care on their own.

Some dental insurance experts question whether dental tourism can ever be anything other than a niche market. Patients who have complicated dental work done also need easy access to follow-up care, those experts say.

But Eng says the low cost of getting dental care from accredited dental offices in Mexico speaks for itself.

For a patient who needs several crowns, going to Mexico can cut the cost of the work to less than $6,000, from a bill of more than $15,000 in the United States, Eng says.

Companion Life Insurance Company, Columbia, S.C., is one of the insurers gearing up for growth in the dental tourism market. It added an insured dental tourism option in November 2009. The company says it believes it is the first national insurer to offer an international dental tourism option to all policyholders.


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