A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Confusion and Cost Create Barriers To Dental Coverage Plans

Confusion and Cost Create Barriers To Dental Coverage Plans

January 10, 2014

For years advocates have worked to share a message that Massachusetts knows well: Oral health is critical to overall health, and dental insurance is health insurance. The messaging looked like it would pay off when dental coverage for children was mandated by the ACA as one of 10 Essential Health Benefits that must be offered by compliant insurance plans. However, as illustrated by this NPR story, the route to expanded access to quality, affordable children’s dental coverage is not as foolproof as one would hope.

NPR’s Julie Rovner reports the gaping loophole present in the new law. Families aren’t required to buy dental coverage for their children when shopping through states’ health care marketplace exchanges. Though the coverage is technically mandated, there are no penalties for families who do not purchase it.

Further, the process by which families obtain pediatric dental coverage presents obstacles in and of itself that could impede families’ access to coverage. These obstacles are twofold: structural confusion and cost.

Both exist in Massachusetts, despite our Connector’s strong support for dental plans.

Because some plans in the marketplace include embedded pediatric dental coverage, while other plans require that coverage be purchased separately, there exists an underlying confusion and inconsistency. Secondly, because these stand-alone dental plans are not eligible for federally-sponsored subsidies, families face an economic disincentive to buy such plans—and the most vulnerable families (namely those with particularly tight budgets) may not be able to afford them at all.

With 1 in 10 children from low-income families suffering from untreated dental problems, the issue of access to dental care is both immediate and widespread. Though the ACA has laid a strong foundation by declaring children’s dental coverage one of its 10 essential benefits, there remains much to be done to ensure that the oral health needs of children across the state are equitably met.

-Jene Bass and Courtney Chelo