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.