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Life Health > Health Insurance > Your Practice

4 things to know about PPACA and dental

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As a result of implementation of the Patient Protection and Affordable Care Act (PPACA), it’s important for employers to recognize that traditional dental plans can be very cost-effective.

More than ever, people are evaluating their health insurance options and many are wondering how dental benefits fit in the mix. As employers continue to evaluate the impact of PPACA and communicate benefit structures to employees, the following four key tenets should be kept in mind, according to Delta Dental.


1. On the public health care exchange, medical plans may include dental benefits for children.

The Pediatric Oral Essential Health Benefit (POEHB) provides:

  • Coverage up to age 19; 
  • Coverage for preventive and restorative dental care;
  • No annual or lifetime benefit maximum;
  • Annual out-of-pocket limit of $700 per child or $1,400 per family, and;
  • Coverage for medically necessary orthondontia (such as for cleft palate).

Some medical plans on the exchange may include the above dental benefits. Medical plans can also exclude children’s dental benefits as long as it is stated in the coverage description. Plus, a traditional dental plan, off-exchange, can additionally provide optional orthodontia and cover dependents to age 26.


2. Not all medical plans pay children’s benefits equally and you do not have to purchase pediatric dental care from a medical carrier.

Many misconceptions remain in the marketplace surrounding the necessity of coverage — the plans are not required to be purchased, only required to be offered.

And because many medical plans may require the policy’s annual deductible and out-of-pocket maximums be met before paying dental benefits, a standalone dental policy may expand benefits and reduce overall expenses.


3. Adult dental coverage is also an option.

Medical plans are not required to offer any dental benefits for adults, but they can be purchased through a standalone dental carrier. Adult dental coverage should be strongly considered.

In addition to its relatively low cost compared with medical coverage, dental coverage encourages regular preventive dental check-ups, which not only helps protect dental health but also can detect as many as 120 different diseases in their earliest stages, when they are most effectively treated.


4. It’s important to evaluate carrier differences between dental networks and plans.

Even though coverage may be similar between different carriers, there are still differences to consider. Some questions to ask include:

  • Which dentists belong to the network(s) offered by the carrier or dental plan? The larger the network, the greater the chance that employees won’t have to switch from their current dentist. Employees and plan members save money since network dentists have agreed to negotiated fees which are lower than their usual fees, and they cannot bill beyond that negotiated fee.
  • Customer service is king. Employers should consider service statistics, such as how quickly calls are answered and issues are resolved.


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