Pediatric dental benefits are a small but important part of the essential health benefits. Implementation, however, presented some big challenges for state and federal exchanges. The Affordable Care Act (ACA) allows dental benefits to be “embedded” in medical Qualified Health Plans (QHPs), or offered as stand-alone products. This differing treatment affects benefit design, availability of financial subsidies, consumer shopping experience, transparency, and the uptake of dental coverage for both children and adults. Most notably, stand-alone dental plans are not included in the calculation of federal tax subsidies and therefore may be unaffordable to many lower-income families.
Over the past year NASHP has been actively tracking implementation of pediatric dental benefits in exchanges. In January, we convened state exchange leaders, and dental and health policy experts to discuss the challenges and potential policy solutions. We then released a comprehensive report in the spring and also highlighted key state decisions in a State Refor(u)mchart.
As the second open enrollment starts November 15, 2014, we are watching to see what changes states may make for the upcoming year. It appears that some states are rethinking and tweaking their pediatric dental offerings. We recently checked in with policy experts at three state-based exchanges—California, Connecticut, and Washington—to look back at decisions the states made on dental benefits in the individual market for the 2014 plan year and to look ahead to changes for 2015 and beyond. Here’s a little of what we learned:
- Covered California offered pediatric dental benefits through stand-alone dental products only in 2014, and did not require that families purchase dental coverage. Data from the first open enrollment showed that just 36 percent of children enrolled in a QHP on the exchange also enrolled in a stand-alone dental policy. With this low take up in mind, for 2015, California asked issuers to submit QHPs that embedded pediatric dental benefits. All the plans participating on the California exchange did so. Also new in 2015, California will be offering stand-alone family dental plans, which include both pediatric and adult benefits.
- In year one, Washington Healthplanfinder offered pediatric dental benefits only through stand-alone dental plans because a state law, HB 2319, required that dental benefits offered in the exchange be “offered and priced separately.” Unlike California, Washington also put in place a mandatory purchase requirement—meaning that families with children age 18 and younger purchasing a medical plan through the exchange were required to purchase a stand-alone dental plan, unless the child qualified for CHIP. Looking ahead, Washington expects to retain the current benefit design structure for children in future years. However, the exchange is considering adding adult dental coverage in 2016. The state is currently doing a cost-benefit analysis for adding enhanced adult dental benefits, using funds from their Level One Establishment Grant to conduct the study.
- In 2014, all medical plans offered on Access Health CT included embedded pediatric dental benefits. By embedding these benefits, the exchange was able to ensure that all children covered through plans purchased on the exchange receive dental coverage. The exchange also guaranteed that pediatric dental benefits would be included when calculating eligibility for federal tax subsidies, which help pay for coverage. In 2014, Connecticut also offered stand-alone dental plans for both adults and children on an external website that was linked to Access Health CT. For 2015, the state is working to fully integrate and enhance its stand-alone dental plan shopping experience on Access Health CT. Also for 2015, Connecticut required embedded pediatric dental benefits for all its standard benefit plans. Each carrier also was able to submit up to three non-standard design plans within each coverage level and can choose to embed benefits or not. For 2015, all plans that will be offered have been submitted, and all include embedded pediatric dental benefits.
As open enrollment nears, we are bound to hear more about what states are doing to improve the integration of dental benefits in their exchanges. If you are involved in this work or have a question, post a comment below or in the oral health discussion. NASHP will continue to track state implementation challenges and decisions related to dental benefits so stay tuned for an updated State Refor(u)m chart, additional resources on this site, and more.
This work was conducted with support from the DentaQuest Foundation.