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Gaps In Kids' Dental Coverage A Trouble Spot

WebMD News from Kaiser Health News

By Marissa Evans

Thu, May 15 2014

No one wants to go to the dentist, but kids need to. A small cavity left to fester can grow into a big health problem. That’s why the government made pediatric dental care one of the health law’s “essential benefits.”

But new data suggest the law is failing to fully deliver on its promise: A lot of parents didn’t buy dental coverage during the recent online enrollment period.  That spells trouble, according to health experts.

By age 5, about 60 percent of U.S. children will have had cavities; 40 percent have them when they enter kindergarten, according to a report from the American Academy of Pediatric Dentists. Children with tooth decay are more likely to have ear and sinus infections. The chance of developing other chronic problems like obesity, diabetes and even heart disease also increases.

Dr. Paul Reggiardo, chairman of the American Academy of Pediatric Dentistry's Council on Dental Benefit Programs, says early dental problems can affect children’s learning, how they interact with other kids and their ability to eat.

“It starts having an impact much more than cavities,” he says. 

Many children get coverage through their parents’ employer-based health insurance or the government-funded Children’s Health Insurance Program and Medicaid, which serve low-income people. But the American Dental Association says there’s still a big gap: 10 million children aged 2 through 18 had no dental insurance in 2011.

The health law marketplaces that opened last year were designed to help people who don’t qualify for Medicaid and don’t have workplace coverage. Parents seeking pediatric dental insurance had two options: purchasing it as part of a family medical plan or as a separate, stand-alone policy.

Federal officials don’t yet know how many kids got dental coverage through a family medical plan in the first enrollment period, which formally ended March 31. But they have reported numbers for stand-alone dental plans sold through the federal website serving 36 states: Just 63,448 children received this coverage.

One reason is shopping for coverage is complicated and confusing – not at all like picking a toothbrush from a shelf, experts say. Perhaps more importantly, there’s no separate subsidy for buying dental coverage and no federal penalty for failing to buy it. Only three states – Kentucky, Nevada and Washington – require parents to buy a children’s dental plan.

In light of these problems, “Are we expanding dental access for kids?” asks Marko Vujicic, chief economist and vice president of the American Dental Association’s Health Policy Institute.

Only 26 percent of medical plans sold on the federal exchange included pediatric dental benefits, according to an ADA study. Parents often confronted difficult choices – the ideal medical plan for their family might not have dental care for the kids, for example. To get that coverage, they’d have to buy a stand-alone plan at an additional cost.

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