Tooth decay is the most widespread chronic condition for children in the United States and one that has gone untreated for too long. In the past, pediatric dental care was not covered under many health insurance plans. That’s no longer the case because of new regulations around dental insurance for kids as introduced under the Affordable Care Act (ACA). As an employer or human resources professional, it’s important to understand these and how they affect you and your employees.
Pediatric Dental Care Requirements
The ACA includes 10 essential benefits that health insurance plans must cover to meet the requirements. One of these benefits includes dental insurance for kids. Currently, these standards apply only to individual health insurance plans and plans for small businesses with fewer than 50 full-time or equivalent employees in most states.
Larger employers, on the other hand, are not required to offer pediatric services in their health-care plans. However, these large employers often still offer more comprehensive dental benefits because they have access to large group dental plans. The ACA standards try to fill the coverage gap for individuals and small businesses that don’t have access to similar benefits of that of the large group plans.
The Importance of Pediatric Dental Care
America has a pediatric dental care crisis and it’s one that the ACA is trying to address. The Centers for Disease Control and Prevention estimate that roughly 17.5% of children aged 5–19 have untreated dental cavities. This is a major health concern and also hurts a child’s future because children with poor oral health are more likely to miss school. In fact, children currently lose roughly 51 million hours of school per year due to dental-related issues, according to the Academy of General Dentistry.
Many of these problems can be prevented by regular visits to the dentist. These provide an opportunity for cleanings, which help prevent cavities, and the chance to teach children about proper dental hygiene practices. The ADA reports that 8.7 million children will gain dental coverage through the ACA by 2018, which will reduce the number of children without coverage by 55%.
The ACA gives every state government the flexibility to determine how insurance companies will meet the new dental insurance requirements in their state. Some states require that the pediatric dental coverage be included as part of health insurance plans while other states prefer standalone pediatric dental insurance policies that you purchase to go along with your company’s health insurance plan. As the American Dental Association (ADA) explains, this pediatric dental coverage must last at least until a child turns 19, although individual states have the option to extend mandatory coverage beyond 19 years of age.
Each state also has different requirements for what must be covered under dental insurance for kids. Stateline reports that in Utah, for example, pediatric dental insurance needs to cover cleanings and sealants but is not required to include more extensive work, such as cavity fillings. Patients may also be required to pay deductibles and copayment.
No Mandatory Coverage for Adults
Although proper dental care remains important in adulthood, the ACA does not extend mandatory dental coverage to adults. For the time being, adults have the option to buy an individual policy or pay for dental care out-of-pocket. As Health Affairs reports, some states are also expanding their health insurance marketplaces to include dental insurance to cover adults as well, so this could eventually become an option for your workforce.
For now, contact your insurance company and confirm that you have the necessary pediatric dental coverage in place. If so, be sure to let your employees know about the new benefits so they can take full advantage for their children. Good pediatric dental care is a launchpad to a lifetime of healthy smiles.