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Health Insurance & Affordable Care Act

Gaps In Kids' Dental Coverage A Trouble Spot

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Stand-alone plans are sold as either high--option policies, which likely involve higher premiums but smaller out-of-pocket costs; or low-option plans, for which premium payments may be less expensive but enrollees may have more out-of-pocket costs. Both cover preventive care and services like fillings, sealants and medically necessary orthodontia, says Evelyn Ireland, executive director of the National Association of Dental Plans. Utah and Michigan don’t offer orthodontia coverage.

Prices for stand-alone plans vary not only by option but also where people live. Insurance markets are regional, not national, so costs and competition vary greatly. For the current year, a family in Cleveland County in southwestern North Carolina could pay as little as $33 a month for a low-option children’s dental plan while another family in Beaver County in southwest Utah could pay as little as $8 for the same level plan, according to a KHN analysis of premium data for the federal marketplace.

In Lenawee County, Mich., a high-option plan was $46 or more; in Miami-Dade County in Florida, that same level plan could be bought for as little as $16. In Davis County, Utah, a high-option plan cost at least $7.

Nationwide, the average price of a low-option plan in a county was $21 and the average for the high option plan was $27.

Open enrollment resumes Nov. 15, but insurers are already developing plans and prices that will be submitted to regulators in the months ahead.

Subsidies and deductibles factor into cost comparisons, further complicating consumers’ choices.

The federal health law provides income-based tax credits for buying medical plans, but not always for buying a separate dental plan. “[Parents]don’t get the same support for picking a dental plan and paying for it as they do with medical plans,” says Joe Touschner, a senior health policy analyst with the Center for Children and Families at Georgetown University.

Deductibles, the amount policyholders pay before coverage kicks in, also vary by plan.

When shopping for a medical plan with built-in pediatric dental benefits, parents will likely want to pick one that has a separate deductible for dental coverage, says Ireland. Otherwise, a child’s dental needs may not be covered until the medical deductible is met. However, in most cases when plans use a single deductible, policyholders are covered for preventive services and do not pay out of pocket, Vujicic said.

The law places limits on out-of-pocket costs. For medical plans with dental care, all spending counts toward the limit. For stand-alone children’s dental plans, the limit is $700 for one child and $1,400 if the plan covers two or more kids.  For 2015, the Department of Health and Human Services lowered the out-of-pocket limits on the stand-alone plans to $350 for one child and $700 for two or more covered children.

Thu, May 15 2014

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