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Health Insurance & Affordable Care Act

Gaps In Kids' Dental Coverage A Trouble Spot

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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.

Ultimately, though, those who bought a dental plan may be left wondering how it works and what it pays for.

“I’m not sure consumers know what they are getting,” Vujicic says.

Correction: This article has been updated. Twenty-six percent of medical plans sold on the federal exchange included pediatric dental benefits.  

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Thu, May 15 2014

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