6. You May Fall Through the Medicaid Gap
An estimated 5 million low-income people aren't getting financial help to buy insurance coverage, because their incomes aren't high enough to earn a subsidy from the federal government. But if their state hasn't expanded Medicaid, they may make too much to qualify for that program.
It's an unusual situation, to make too little to get help from the feds but too much to get help from the state. That's the way things stand, though, in the 25 states that have declined to expand Medicaid.
"We need to take the long view," says Aaron Katz, a principal lecturer at the University of Washington who studies health care expenses. "It took 17 years after original enactment of Medicaid for all 50 states to join in. I expect the vast majority of states to adopt the expansion in the next 5-10 years. The pressure from hospitals, doctors, and businesses, already evident in some of the ‘no’ states, will grow as they realize how much they're paying for their states' denials."
7. Dental Coverage Isn't Guaranteed, Except for Kids
If you get insurance through a federal or state Marketplace, it likely won’t include dental care. Insurers aren't required to offer dental care -- except for policies that cover children -- and you won't pay a penalty if you go without dental coverage for yourself or for children. Public health advocates pushed hard to have pediatric dental care included. The efforts were fueled in part because of a Maryland boy, who died in 2007 from a bacterial infection that spread from an abscessed tooth. His family had lost their Medicaid coverage.
Why is dental coverage treated differently from other kinds of medical coverage? The law's framers stayed away from universal dental coverage because they feared losing the battle in Congress if costs got too high, says Jeff Album. He is vice president of public and government affairs with Delta Dental, a dental insurance company.
Historically, about 99% of dental plans are sold separately from medical plans, Katz says.