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How will Obamacare impact dental benefits?

The Affordable Care Act, also known as Obamacare, mainly deals with health care coverage, but it also has important consequences for dental coverage.

Obamacare protects consumers against some of the most expensive dental claims. It also increases access to dental coverage through Medicaid and the new health insurance exchanges in each state.

The American Dental Association estimates that 8.7 million children and 17.7 million adults are expected to gain dental benefits as a result of Obamacare. However, children stand to benefit the most from the changes.

dental benefitsIn individual and small group plans, there will be no lifetime or annual limits for dental care for children up until age 19, says Evelyn Ireland, executive director of the National Association of Dental Plans, which represents dental insurers.

In addition, plans will include an out-of-pocket maximum. That means consumers won't have to spend more than $750 or $1,000 per year on pediatric dental care, depending on the state. The insurer will pick up the rest of the cost after the consumer pays the maximum.

However, not all dental care will be covered by the new law. For example, orthodontic care for children, such as braces, is covered only if it's medically necessary.

It's too early to tell whether having this out-of-pocket maximum for children’s dental services will cause an increase in monthly premiums.

Ireland notes that Obamacare won’t change dental coverage for adults who are in an employer's large group plan. An employer's group plan is considered large if the employer has more than 50 employees.

Why do you need dental care?

Dental care is important because there's a strong connection between oral health and overall health. Left untreated, tooth decay (cavities) can lead to a blood infection, a brain infection or death in extreme cases. Gum disease may increase the risk of heart disease, dementia and diabetes.

Dental cavities are the most common chronic disease of children ages 6 to 11 years and adolescents aged 12 to 19 years, according to the U.S. Centers for Disease Control and Prevention.

Obamacare dental benefits

Health insurers aren’t required to cover dental services for adults. Some of the health insurance exchanges may offer stand-alone dental plans for adults, or plans with both health and dental coverage for adults.

For example, Delta Dental, one of the nation’s largest dental insurers, says it will participate in exchanges in 15 states and the District of Columbia as a standalone dental plan and in conjunction with health plans where possible. Those states include California, New York and Texas.

Children's dental services are part of the essential benefits package health plans must offer if they participate in the exchanges that will open in each state, starting enrollment Oct. 1, 2013, for coverage to take effect Jan. 1, 2014.

Ireland says consumers will "have many different options at different price points."

The American Dental Association estimates that 3 million children will gain dental coverage through the exchanges alone by 2018, a 5 percent increase over the current number of children with private dental coverage.

However, if the child's dental services are covered through a health plan, some parents may consider dropping the family's standalone dental plan altogether. The National Association of Dental Plans estimates that this could lead to 10 million fewer American adults having dental insurance.

Medicaid dental benefits

Depending on income level, some patients could qualify for Medicaid's dental coverage. States must provide dental benefits to children who are covered by Medicaid and the Children's Health Insurance Program (CHIP), but each state can choose whether to provide dental benefits for adults.

Starting in 2014, the Affordable Care Act will expand Medicaid to cover Americans under age 65 with an annual income up to $15,281 for a single person or $31,321 for a family of four.

However, the U.S. Supreme Court ruled that states can opt out of this Medicaid expansion. As of September 2013, 24 states and the District of Columbia plan to expand Medicaid eligibility, while 22 opted out and four are still debating the decision, according to the Kaiser Family Foundation, a nonprofit organization that studies health care issues.

The American Dental Association estimates that 5.3 million adults will gain dental coverage as a result of Obamacare, almost all due to the Medicaid expansion.

Tax concerns

Under the Affordable Care Act, some Americans can get a tax credit for buying health insurance though one of the exchanges, if they meet the income requirements. You will be eligible for a health care tax credit if your annual income is between 133 percent and 400 percent of the federal poverty line. That means between $15,281 and $45,960 for a single person, or between $31,321 and $94,200 for a family of four, in most states.

A number of advocacy organizations and medical groups, including the Children's Dental Health Project, the American Dental Association and the American Academy of Pediatric Dentistry, are lobbying federal agencies to try to change the tax treatment of standalone dental plans for children.

Under current Internal Revenue Service rules, a family won't get the full premium tax credit for standalone pediatric dental coverage, says Patrice Pascual, executive director of the Children's Dental Health Project, a Washington, D.C.-based nonprofit organization that advocates for children's oral health. 

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