If you're a parent, you probably want to make sure your kid has a healthy mouth and nice teeth without breaking the bank. The good news: Provisions in the Affordable Care Act (also known as Obamacare) might make it easier to reach that goal.
Children's dental health coverage is one of Obamacare’s 10 essential health benefits, broad categories of coverage included in individual and small group plans sold inside and outside of the health insurance marketplaces.
But parents have choices on how to get dental coverage for their kids. Though children’s dental coverage is an essential health benefit, states are not required to make insurers include the coverage in health insurance plans sold on the exchanges; instead, states can offer separate dental plans.
In the exchanges, parents can buy dental health coverage included as part of a medical plan or they can buy a separate dental plan in the exchange, according to "Buying Children's Dental Coverage Through the Marketplace," a new guide from the Children's Dental Health Project (CDHP) and Families USA.
So, if you have kids, should you get their coverage as part of your medical insurance or buy them a stand-alone dental insurance plan?
"There isn’t a single right answer for everybody," says Evelyn Ireland, executive director of the National Association of Dental Plans (NADP), a dental insurance trade association.
Here are five things parents should consider when making a decision about children's dental health coverage.
1. Full health insurance plans have more consumer protections than stand-alone dental plans.
There are some ACA requirements that apply to both health insurance plans and stand-alone dental plans, according to the guide from the CDHP and Families USA. For example, both must have adequate provider networks, plans that cover only children, and no annual or lifetime caps on the dollar amount of care.
These rules mean both types of children's dental coverage pay for more care now than in the past, says Colin Reusch, senior policy analyst for the CDHP. "You're not cut off after you rack up $1,000 in covered services," he says. However, health plans include additional protections not required of stand-alone dental plans -- for example, they can't refuse coverage or charge more due to a preexisting condition. Also, these insurers must spend 80 percent of premiums on care and they must allow you to get a third party to review any denial of coverage for a certain service.
2. Subsidies apply to health insurance plans but not stand-alone dental plans.
The guide from the CDHP and Families USA points out that, if you qualify for subsidies to help pay your health insurance premiums, it might help free up some money in your budget to buy a separate dental plan. But you can't get federal financial assistance to pay the premiums for that dental plan.
3. It's important to look at specifics of what a plan covers.
Most plans cover basics such as teeth cleaning, X-rays and fillings. They also cover orthodontic care such as braces, but only when it is needed to correct a specific problem such as trouble chewing or speaking, according the guide from the CDHP and Families USA. Parents should be clear on coverage details and costs before choosing a plan, Reusch says.
4. For both health insurance and dental plans, it's important to check the provider network.
Check to see whether your child's dentist is listed as an in-network provider for any plan you're considering, Ireland recommends. It's less important to look at specialists, she says, since 95 percent of children can get treatment from a general dentist. However, parents might also want to look at which orthodontists are in-network on the plan in case their child at some point qualifies for medically necessary orthodontia, she says.
5. If you're considering using coverage included in a health insurance plan, look at specifics of cost sharing.
If you get children's dental coverage that's included in a health insurance plan, your medical and dental spending will count toward one annual out-of-pocket maximum, according to the report CDHP and Families USA. However, some of these plans have one deductible for both medical and dental care -- which could be $1,500 or even higher, Ireland says. The out-of-pocket maximum for 2014 is $6,350 for an individual plan or $12,700 for a family plan.
Others have two separate deductibles, including a much lower one -- possibly around $25 to $50 -- just for dental care, Ireland says. Parents whose kids are healthy but might need expensive dental care might want to consider a plan with a separate dental deductible, according to the guide from the CDHP and Families USA. Otherwise, parents could end up paying out of pocket for items such as fillings. "It's better to investigate first than be surprised later," Ireland says.
And there's one other important matter parents should think about: their own coverage, Ireland says. Consumer surveys show that about half of parents who currently buy separate dental coverage for the family might consider dropping the plan -- and with it, their own coverage -- if their kids get covered under a health insurance plan, according to the NADP. That's a bad idea because half of adults with dental coverage go to the dentist regularly, compared with 18 percent who don't have coverage, Ireland says.
Regular dental visits are important so your dentist can spot problems, like cavities and gum disease, early. When ignored, these issues can advance and become difficult and expensive, to treat, according to the American Dental Association.
"Keep your coverage and use it to go to the dentist at least annually," Ireland says.