Legal Loopholes Leave Some Kids Without Dental Insurance : Shots - Health News Dental coverage is a required benefit for children under the Affordable Care Act. But it's not turning out to be quite that simple. For one thing, there are no federal subsidies to help pay for stand-alone dental policies.
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Legal Loopholes Leave Some Kids Without Dental Insurance

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Legal Loopholes Leave Some Kids Without Dental Insurance

Legal Loopholes Leave Some Kids Without Dental Insurance

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We have heard many a story about how complicated signing up for the Affordable Care Act has been for people. Turns out buying dental coverage on the health exchanges - not so simple either. One aim of the new law is to protect the teeth of millions of children. It actually lists pediatric dental care as one of the 10 essential benefits health plans have to offer. But as NPR's Julie Rovner reports, a loophole means that in most states families don't actually have to buy the coverage.

JULIE ROVNER, BYLINE: Okay. Full disclosure here. It turns out that dental coverage under the Affordable Care Act is so confusing, it tripped me up. I said earlier this week that because dental coverage for children is one of the law's required benefits, it will be included in all health plans in state exchanges. That turns out mostly not to be the case, except in a handful of states, including Connecticut, which requires it.

JOE TOUSCHNER: It is very complex.

ROVNER: Joe Touschner is a policy analyst with the Georgetown University Center for Children and Families. He's been tracking implementation of the pediatric dental benefit. He says the problem is that when Congress wrote the law, it was trying to satisfy two different goals.

TOUSCHNER: On one hand, they did make it part of the essential health benefits package. They said, you know, dental services are part of that.

ROVNER: But at the same time, he says, in part due to some strong lobbying from dental benefit providers, Congress also wanted to preserve a market that looked a lot like the current one.

TOUSCHNER: And in most cases now, if you have dental coverage, you get it through an employer, and it's offered separately from your health plan. You choose a health plan, but then you also choose a dental plan. So similarly in the exchanges, there's health plans and then there are separate dental plans.

ROVNER: So in some states there are only standalone dental plans and in some states there are both standalone plans and health plans that have children's dental benefits included. But there's another catch, says Colin Reusch. He's with the Children's Dental Health Project, a nonprofit group based in Washington, D.C.

COLIN REUSCH: We've got this loophole whereby families can choose not to purchase dental coverage for their children even though it's part of the essential health benefits. You know, we seem to have, you know, some disincentives to purchasing it.

ROVNER: That loophole was that while the law requires that pediatric dental coverage must be offered, families who don't buy it won't be penalized. And the disincentive? If a family buys standalone dental coverage, they won't get any federal subsidy even if they're eligible for help buying their overall health plan.

REUSCH: So if that plan doesn't include pediatric dental coverage, then you're getting no subsidy for dental coverage at all, period.

ROVNER: Another problem with dental coverage in the exchanges is it can be downright difficult to find. In a handful, it's not so hard, says Fay Donohue. She's president and CEO of Dentaquest, a dental benefits company that's providing standalone plans in some states and coverage that's part of health plans in others.

FAY DONOHUE: In some states, for example, Maryland or Massachusetts, you can go onto the exchange and shop just for dental and are able to pick a dental plan for yourself that makes sense and is a easy experience.

ROVNER: In other states, however...

DONOHUE: It is extremely difficult, in others pretty impossible.

ROVNER: Donohue says this is a problem not just for the bottom line of dental firms. Unmet oral health needs, particularly those of children, are a serious health problem. She says it's estimated that one in 10 children from low income families are in pain from untreated dental problems.

DONOHUE: How can you go to school and learn anything when you're in pain? You know, if you care about education, you've got to care about oral health.

ROVNER: That difficulty of finding plans extends to adults too. Under the health law, any adult who doesn't have dental coverage should theoretically be able to just go to the exchange and buy a plan. But Donohue says that's not happening either.

DONOHUE: In some you can. In some you can only buy a dental if you've already purchased a medical.

ROVNER: And in some, she says, dental plans are all but impossible to find. Meanwhile, children's advocates say their first priority is making sure families who do buy standalone dental coverage for their kids get subsidies if they're eligible. Julie Rovner, NPR News, Washington.

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