ADA Releases Report on Initial ACA Pediatric Dental Insurance Plans

Approximately 8.7 million children are expected to gain some form of dental benefits by 2018 as a result of the Affordable Care Act (ACA), an increase of 15 percent relative to 2010. Three million of these children may gain dental benefits through health insurance marketplaces. Overall, these changes are predicted to reduce the number of children without dental benefits by about 55 percent. However, due to the wide variation among states on how dental benefits are offered within the newly established health insurance exchanges, much confusion and misperception lurks amongst both providers and purchasers of dental benefits.


The American Dental Association (ADA) Health Policy Resources Center recently released a Research Brief entitled Health Insurance Marketplaces Offer a Variety of Dental Benefit Options, but Information Availability is an Issue. [i] This represents the best available information to date concerning ACA pediatric dental insurance options. Among the important findings:

€        The lack of a Stand-Alone Dental Plan (SADP) purchase mandate within exchanges is having a negative impact as expected, as only 27 percent of children enrolling in medical plans (without dental coverage) also enrolled in a SADP. 

€        Overall 3,180 medical plans and 697 SADPs were offered. SADPS were offered in every state. Among all medical plans, 26 percent had embedded pediatric-only dental benefits. In seven states there were no embedded plans.

€        Insurance exchange website information on dental benefits within embedded plans was much more limited than SADPs. For example:

o    " . . . the majority of medical plans with embedded pediatric dental benefits do not clearly state whether they cover any services beyond preventive dental care. Information on coinsurance levels and copayment amounts is even more limited." "It is still unclear whether minor restorative services, major restorative services, and orthodontia services are covered within some medical plans." 

o    Only 20 percent of the medical plans clearly stated there was a separate dental deductible. "However, 34% of medical plans do not use a separate dental deductible. In these cases, the average combined medical plus dental deductible is $2935."

o    " . . . 24% of the medical plans do no provide consumers with any information on in-network dental providers."

€        A bit of good news is that "the vast majority of medical plans without a separate dental deductible do not apply the deductible to preventive services." Of course, how preventive services are defined is critical.

€        "Even among SADPs, 26% of plans apply the deductible to preventive services.  While the average deductible amount for SAPDs is much lower [than embedded medical plans], there is still an important finding that some SADPs are not providing first-dollar coverage for basic preventive dental care services."

€        "The average high actuarial value SADP pediatric premium is $38.89 [per month], ranging from an average of $27.91 in Nebraska to $77.24 in Alaska. The average low actuarial value SADP pediatric premium is $30.98, ranging from an average of $23.32 in Nebraska to $52.92 in Alaska. 

To view this comprehensive report, please go to:<​/a>


[i] Yarborough, C., Vujicic M., Nasseh, K. (2014) Health insurance marketplaces offer a variety of dental benefit options, but information availability is an issue. Health Policy Resources Center, American Dental Association.  Chicago, IL.



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