Public exchange managers in some states are already starting to decide how they’ll handle dental benefits in 2015.
Wakely Consulting Group has developed a 55-page report on dental coverage options for the board of Covered California, California’s public exchange.
The Patient Protection and Affordable Care Act requires all individual and small-group plans to offer a package of 10 “essential health benefits” starting in 2014. The EHB package includes requirements for dental and vision services for children.
Dental policymakers have come up with the following terms to refer to exchange plans:
- 10.0 plan: An exchange medical plan — or “qualified health plan” — that includes all 10 EHBs, including “embedded” pediatric dental benefits.
- 9.5 plan: A QHP that excludes pediatric dental benefits,
- 0.5 plan: A stand-alone dental plan that includes pediatric dental coverage.
PPACA lets exchanges offer “0.5 plans,” or stand-alone dental plans, but it’s not clear whether consumers can use the new PPACA health insurance tax credits to pay for stand-alone dental. Exchanges have not been sure to apply PPACA plan design rules to stand-alone dental.
This year, a carrier can make any QHP a 9.5 plan if the issuer is selling the QHP through an exchange that offers stand-alone dental.
Some children’s advocates are afraid the allowing the sale of 9.5 plans will lead some parents to go without dental coverage for their children.
The Covered California board is thinking of requiring QHPs to embed pediatric dental benefits and getting rid of 0.5 plans, or possibly allowing the sale of both 10.0 and 9.5 plans along with 0.5 plans. The consultants estimated an all-10.0-plan approach could cut the cost of pediatric dental to $3 per child per month, from $15 per month for options involving 0.5 plans.