New ADA Report Shows Lack of True Mandate for Pediatric Dental Benefits Limits ACA Enrollment

April 21, 2014 11:28 AM
The ADA Health Policy Resources Center has released a second report related to Affordable Care Act (ACA) insurance plans (see new analysis), finding that enrollment in stand-alone dental plans (SADPs) in the newly-established health insurance marketplaces varies considerably from state to state. Idaho has the highest enrollment rate for children and Alabama the highest for adults. Overall, the enrollment of children in SADPs is low when compared to ACA objectives. Initial data suggests the lack of a true mandate for pediatric dental benefits within the health insurance marketplaces is having important consequences. This is an issue that the AAPD raised in Congressional visits during our Public Policy Advocacy Conference in Washington, D.C., March 3-5, 2014. The problem is that within health insurance exchanges, if a family purchases a medical plan lacking pediatric dental coverage, a SADP must be offered but it is not required to be purchased. Outside of exchanges in the individual and small group market, a medical insurer offering such a plan must be "reasonably assured" that the enrollee also purchased a SADP. While this is not an issue for those who purchase a medical plan with "embedded" pediatric dental coverage, many of those plans have features that pose barriers to utilization.
The AAPD will feature an update on the ACA at the Annual Session in Boston on Friday, March 23, 2014 (see course 180).

Back to News