Health Reform and Kids' Dental and Vision Care

The Affordable Care Act makes vision and dental care available to more children. The law requires that insurance companies offer these benefits for children in all health plans offered in the Marketplace, in the individual market, and through employers with 50 or fewer employees.

But plans that have grandfathered status -- those that were in place before the Affordable Care Act became law on March 23, 2010, and have not substantially changed -- don't have to offer this type of coverage. Also, the law doesn't require that large companies -- those with more than 50 employees -- offer dental and vision services for children, though the majority already do.

Your children may also get care for their eyes and teeth through two programs for people with low incomes: Medicaid and the Children's Health Insurance Program (CHIP). You have to qualify for those programs, based on your income, for your children to be covered.

Vision Benefits for Kids

Children up to age 19 can get an eye exam every year under the Affordable Care Act.

If your child has a vision problem, your insurance might help with treatment, though the benefits vary depending on your health plan. Where you live matters, too. In some states, you may have to pay some of the cost of your child's glasses or contacts. Check your health plan's summary of benefits carefully to be sure. You will likely have to use a provider from your plan’s network in order to receive these benefits.

If you qualify, programs like Medicaid and CHIP -- for families with low incomes -- usually cover the cost of glasses or contacts to correct vision problems.

Dental Benefits for Kids

Under the Affordable Care Act, dental health coverage for kids up through age 19 is an essential health benefit. If you buy a policy from your state's health insurance Marketplace, dental coverage for your kids must be included or at least available.

You can get dental coverage for your kids in two different ways.

  • You might get it through your general health plan.
  • Or, in some cases, you might have to buy a separate stand-alone dental plan.

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What will your child's dental plan cover? That varies from state to state. But many plans will cover things like:

  • A dental exam every 6 months
  • Cleanings, fluoride treatments, and X-rays
  • A portion of expenses for braces

The benefits in your state and specific plan may be different. Also, your plan may require you to visit an in-network dentist to get these benefits. Make sure you understand what dental care is covered -- and what isn't -- before you buy a plan.

If you qualify, your child may also get dental coverage through programs like Medicaid and CHIP. The kinds of care also vary by state, but in general, they must include services to:

  • Keep your child's teeth healthy
  • Relieve pain or infection
  • Restore teeth

Other Help From the Affordable Care Act

You and your children will get protections from the Affordable Care Act for vision and dental problems:

  • Your children cannot be turned down for coverage because they already have a vision or dental problem.
  • The amount of money you pay out of pocket for care and prescriptions is capped. This means your costs will not go over a certain total each year.
  • Annual and lifetime limits on how much insurance will pay are no longer legal.

Vision and Dental Care for Adults

As an adult, you won't get much benefit from the Affordable Care Act when it comes to vision or dental care. The law does not require insurers to extend dental and vision benefits to adults.

Medicare does not cover routine vision or dental care either. Medicare does cover things like cataracts surgery, glaucoma tests, and eye exams for diabetics. If you have Medicaid, it's up to your state to decide whether vision or dental care for adults will be covered.

Most Marketplaces throughout the country will sell adult and family dental plans. Call or log onto your state’s Marketplace to learn what is available where you live.

WebMD Medical Reference Reviewed by Amita Shroff, MD on July 16, 2018

Sources

SOURCES:

American Academy of Pediatrics: "Health Reform and the AAP: What the New Law Means for Children and Pediatricians," "Promoting Oral Health."

American Association for Pediatric Ophthalmology and Strabismus: "Vision Care and The Patient Protection and Affordable Care Act."

American Academy of Ophthalmology: "Children and Vision Care."

Children's Dental Health Project: "FAQ: Pediatric Oral Health Services in the Affordable Care Act."

The Vision Council: "Patient Protection and Affordable Care Act and the Vision Community."

U.S. Preventive Services Task Force: "USPSTF A and B Recommendations."

AARP: "What Medicare Covers."

Families USA: "About Medicaid."

U.S. Department of Health and Human Services: "Early and Periodic Screening, Diagnostic, and Treatment."

Healthcare.gov: "Can I Get Dental Coverage in the Marketplace?"

American Dental Association: "Affordable Care Act, dental benefits examined."

National Association of Dental Plans: "ACA and Dental Coverage -- The Basics."

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