Your Child’s Oral Health and the Affordable Care Act

How Will the Affordable Care Act effect my child’s dental coverage? Dental benefits for kids under the Affordable Care Act explained.

Parents understandably have questions about the new Patient Protection and Affordable Care Act and their children’s oral health.  We are often asked ‘Will my child have coverage for her dental needs?’

Under the Federal Affordable Care Act, children’s dental coverage is one of the 10 essential health benefits required to be included.  Good dental health care and its impact on children’s overall health is well-documented. Beginning in 2014, affordable dental coverage will be available for children under the age of 19. In 2015, it appears that pediatric dental coverage will be embedded in comprehensive health insurance plans and will likely be mandatory.

Although the Affordable Care Act, in its entirety, is somewhat in flux at this writing – with our Congress at odds over portions of the law, here is a synopsis of what will be available for your child in 2014:

Low-income families

Many families will still be eligible for low-cost or no-cost Medi-Cal coverage for their child.  In 2014, Medi-Cal is expanding their coverage.  For good information on common questions, the California Department of Healthcare Services offers this page:  http://www.denti-cal.ca.gov/WSI/Default.jsp?fname=Default

In addition, the Affordable Care Act through Covered California will offer premium assistance for children’s dental coverage in the same way they do on all health insurance plans.  Even if you don’t qualify for Medi-Cal, you may meet the requirements for Federal Government premium assistance with your child’s dental coverage.

Plans Available Through Covered California in 2014

There are a number of plans available for children’s dental coverage beginning in January, 2014.  ‘Stand-alone’ plans (those not tied to a major medical health insurance plan) will be available.  In 2015, the plan is to begin to embed those dental plans into the portfolio of comprehensive medical insurance products. 

Premiums for children’s dental insurance in Region 1 (Nevada County) vary from $9.60 per month to $37.98 per month, depending on the carrier and amount of coverage.  These premiums don’t include any discounts for premium assistance, which is dependent on income and will be offered on a sliding scale.

There are five insurance companies offering plans to families who purchase individual insurance through Covered California:  Anthem Blue Cross, Blue Shield of California, Delta Dental, Liberty Dental, and Premier Access.  For more information, click on ‘Children’s Dental Insurance Plans’ using this link:  https://www.coveredca.com/coverage-basics/plans.html

You may also visit the Covered California website to ascertain if you qualify for premium assistance or Medi-Cal.  We used a sample family of four and checked the Covered California ‘Shop and Compare’ tool.  Our make-believe family  –  two adults aged 38 and 40, two minor children and an annual income of $57,884 (which represents the median income for a family in Nevada County) and found that the children likely qualified for Medi-Cal Kids.  You can check out their ‘Shop and Compare’ tool here:  https://www.coveredca.com/shopandcompare/#calculator

What if I already have dental coverage for my child?

If you already have dental coverage for your child through an employer, you won’t be required to take any action.  Many employers offer dental coverage to employees and their families as a part of their benefits package.  Employers with over 50 employees will be required to offer group coverage to their employees, and must pay at least 50% of the premium.

According to Covered California, they expect that all of California’s children will have access to affordable, quality dental care.  This is good news for families in Nevada County. Dental benefits for kids under the Affordable Care Act are fairly comprehensive.

As the Patient Protection and Affordable Care Act unfolds, we will provide you with the most up-to-date information on coverage for your child’s dental needs.

If you’d like more information right now, 2-1-1 Nevada County has telephone numbers you may call and planned dates for Community Public Forums, which you may wish to attend.  http://211nevadacounty.org/health-care-enrollment-and-medi-cal-changes-begin-october-1st/

 

Our goal is that all children receive the important oral health care and education they need to enjoy lifelong dental health and the confidence of a beautiful smile!