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Health Care Reform Affects Dental, Too

By Jill Hamilton on October 1, 2013 in Company News


Jeff Russell, CEO of Delta Dental of Iowa
Jeff Russell, CEO of Delta Dental of Iowa

When I joined Delta Dental last May, the Affordable Care Act (ACA), also known as health care reform, was already turning the health care industry on its head. And dental benefits are not exempt from the changing health care landscape. After all, behind medical and retirement savings plans, employees request dental benefits the most of any benefit.

The law is complex, but here are key things to know about ACA and your dental benefits:

Effective January 1, 2014, health plans offered to small groups and individuals will include the 10 essential health benefits (EHBs).
The government has defined 10 EHBs that must be offered by health insurers. One of them is pediatric oral and vision care. After all, according to the Centers for Disease Control and Prevention, childhood cavities are the “most common childhood disease.”

In 2014 pediatric dental benefits must include:

  • • 100% coverage for diagnostic and preventive care;
    • Coverage up to age 19;
    • No annual or lifetime benefit maximum, and;
    • Medically necessary orthodontia.

The ACA exempts large businesses (51+ employees) from meeting the EHB requirement because their health plans generally include these benefits.

You have options when it comes to your dental care
Recognizing that the majority of consumers purchase dental insurance through a stand-alone dental carrier such as Delta Dental, the Iowa Insurance Division is not requiring medical carriers to include pediatric dental EHB in their health policies. In fact, 97 percent of all dental plans are purchased as a separate benefit.

Some medical plans may include (or sometimes called embed) the pediatric dental benefit but these plans may not pay for benefits until the annual deductible and out-of-pocket maximum have been met. Therefore, it's important that you and your employees thoroughly understand your medical plan's pediatric dental provision.

What about adult dental care?
In the reformed health care environment, dental benefits are different for adults than for children. There is no requirement in the ACA for adult dental care. Yet having access to dental benefits encourages individuals to get regular preventive dental check-ups, which not only helps protect dental health but can detect as many as 120 different diseases in their earliest stages, when they are most effectively treated.

Preventive dental care has been shown to improve employee's overall health, reduce absenteeism, increase job satisfaction and ― ultimately ― save both employees and employers health care dollars.

Dental care is smart health care for everyone.
Because having access to the right dental benefits is so important, Delta Dental has worked hard to create plans that meet the required ACA pediatric dental benefit. Per-person pricing makes it easy for employees to cover themselves, their spouse and/or their children. And our small business plans also allow enrollees to carryover unused benefits from one year to the next. That's can be a significant savings.

Smile ― Delta Dental is ready to help.
Whether or not your business chooses to offer a separate dental plan, Delta Dental is committed to helping you understand the ACA requirements and your options, and to improving the dental health of all Iowans. For more on how the ACA affects your dental benefits and other information on health care reform visit www.deltadentalia.com/answers.