Designers of the new “essential health benefits” (EHB) package should make sure that consumers have the ability to compare dental plans and buy dental coverage separately from medical coverage.
Dr. William Kohn, a representative of the Delta Dental Plans Association, Oak Brook, Ill., makes that argument in testimony presented to the U.S. Department of Health and Human Services (HHS).
HHS is now conducting regional listening meetings to get information and opinions regulators will use as they are creating the EHB.
The Patient Protection and Affordable Care Act of 2010 (PPACA) calls for HHS to define an EHB package.
If PPACA takes effect as written and works as drafters expect, individuals and small employers will be able to use new federal subsidies to buy health coverage through a new system of health insurance distribution exchanges starting in 2014. Plan managers will have to help consumers and others compare plan costs, on and off the exchanges, by stating what percentage of the actuarial value of the EHB package that each major medical plan sold covers.
A bottom-level “bronze” plan must cover 60% of the actuarial value of the EHB package, and a top-level “platinum” plan must cover 90% of the actuarial value of the EHB package.
PPACA requires the EHB package to include dental benefits for children.
Kohn, a former director of the Division of Oral Health at the Centers for Disease Control and Prevention (CDC), is now a vice president at Delta Dental, an association that represents a national system of large, nonprofit dental plans. The plans provide dental coverage for 56 million people, including 18 million children.
Kohn notes in a written version of testimony delivered at an HHS meeting in October that scientists are finding evidence that problems with oral health can hurt an individual’s overall physical health.
“Fortunately, dental disease is also highly preventable, and cost-effective, science-based preventive therapies exist to virtually eliminate dental disease if applied at the right time, at the right frequency, and to the right children,” Kohn says in the written testimony.
CDC figures show that just 20% of the children ages 2 to 19 get 80% of all the cavities that children get, and many of the children who get the cavities are low-income children who lack regular access to dental coverage and dental care, Kohn says.