Dental Coverage Deciphered, And The Latest On Sign-Up Deadlines : Shots - Health News Children automatically get dental coverage through Affordable Care Act policies, and adults can buy dental insurance if they wish. That's one of the big changes under the health care law. And everyone has until March 31 to buy insurance and avoid penalties.
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Dental Coverage Deciphered, And The Latest On Sign-Up Deadlines

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Dental Coverage Deciphered, And The Latest On Sign-Up Deadlines

Dental Coverage Deciphered, And The Latest On Sign-Up Deadlines

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This is MORNING EDITION, from NPR News. Good morning, I'm David Greene.

Today in Your Health, we're answering more of your questions about the Affordable Care Act. And a lot of questions, there have been. Things do seem to be going a lot better on the website. Federal officials say more than a million people enrolled in coverage by the Christmas Eve deadline. That was if people wanted their coverage to begin on Jan. 1st.

But there are a lot of questions about the deadlines and a lot more. And so we've brought in NPR's Julie Rovner, who is back to give us some answers. Hey, Julie.


GREENE: OK, so we're passed that deadline. People who wanted the coverage to begin on Jan. 1st, they have their coverage. Now, we're moving on to lots of other deadlines, and that's where our questions actually start. One from Catherine Baer of Poughkeepsie, N.Y. She seems to be confused, like a lot of us. She writes: If one were to sign up in January, when would that coverage start? Let's say one signed up on Jan. 10, 2014. So how do you answer that?

ROVNER: Well, people can be forgiven for being confused about the dates, because the dates do keep changing.

GREENE: A lot.



ROVNER: At least for now, they're supposed to work like this: As long as you sign up by the 15th of the month, your coverage starts on the first of the month after that. So if you sign up by the 15th of January, your coverage starts Feb. 1st. If you sign up on the 16th of January, though, you'll have to wait until March 1st. Same with February - sign up by the 15th, your start date is March 1st. But if you wait until Feb. 16th, you'll have to wait until the first of April. Now, open enrollment ends March 31st. Those people's coverage won't start until May 1st.

GREENE: So if you don't sign up by March 31st, that's when we start talking about penalties. And that's where, actually, our next question goes. We have a question from Anne Vanderhorst of Lexington, Ky. And she has a question about tax penalties for people who don't sign up for health insurance.

ANNE VANDERHORST: If you do get covered at some point during 2014, is the penalty prorated or does it not matter?

GREENE: OK, Julie, tell us a little about how the penalties work.

ROVNER: Well, now that it's 2014, most people will have to have health insurance or be subject to that penalty we've been hearing so much about. This first year, the penalty is fairly small. If you're without insurance for the entire year, it's the larger of $95 or 1 percent of your income, for an individual. It goes up in future years.

But if you don't have insurance, as we just mentioned, you have until the end of March to buy coverage. That's because you can be without insurance for up to three consecutive months and not pay any penalty. And yes, Ms. Vanderhorst, the penalty is prorated.

The way it will be asked when you fill out your 2015 taxes is whether your had health insurance in 2014, and for how many months. For every month you lacked insurance over three, you pay a penalty, per family member, per month. And if you don't earn enough to file income taxes, you're not subject to the penalty, by the way.

GREENE: Ah, if you're not filing income taxes, you're not subject to the penalties. Seems like an important point.

ROVNER: That's a very important point.

GREENE: More questions about the penalty we received, one of them specifically about which plans satisfy the requirement for having adequate coverage. And this question comes from Chris Rickels of Covington, Ky.

CHRIS RICKELS: I'm a part-time worker, and my current employer offers health insurance that does not meet the minimum standards of the Affordable Care Act. I talked to someone at the call center for the Affordable Care Act, and was told that as long as I had health insurance through my employer, I would not be fined. So I bought that health insurance and now, I'm hearing differently from my co-workers and - that I might be fined.

GREENE: OK, Julie, so which is it? This gentleman has health insurance through his employer, but it's not insurance that satisfies the law.

ROVNER: You know, I had to do a little investigating on this one, just to be sure. And yes, the call center operator was correct. As long as you have employer-provided insurance, you're OK, and you're exempt from any fines. Once the requirement for employers to provide coverage takes effect, the employer might be subject to a fine, but that's been put off a year.

Now, if Mr. Rickels wants to drop his employer coverage and go to the exchange and buy a more comprehensive plan, assuming his coverage doesn't cover 60 percent of typical health expenses, he would probably be eligible for a subsidy. That's assuming he doesn't earn more than four times the poverty level - about $46,000. But if he's just worried about not paying the penalty, then he's OK.

GREENE: Seems like there's a new wrinkle everywhere, with this law. So we got an e-mailed question from Robert Dodelin from Mount Laurel, N.J. And he is losing his current health insurance this month and will be going to the exchange. And he wants to know about financial information that he'll have to provide when he applies for health insurance. So what documents should people have ready?

ROVNER: This is a really good question because it turns out there's quite a bit of paperwork involved. And that's even though health plans can't ask you about your medical history anymore. But because of the availability of premium subsidies, they want to know a lot about who you are and how much you earn.

So what you'll need is proof of identity - either your Social Security number or legal immigrant status; you'll need employer and income information, which can include pay stubs or W-2 forms or if you're self employed, last year's tax return. The application also asks for information about any employer health insurance that's available to you or members of your immediate family because that affects your eligibility for government help paying for individual insurance. So gather all that stuff up before you go to the website, or before you meet with someone who's helping you apply for coverage.

GREENE: Word to the wise: Have it all ready. So Julie, this next question from Ami Rowland of Brighton, Colo., is about dental coverage under this law. I feel like it's not something we've talked much about.

AMI ROWLAND: My question is: Do I have to purchase dental insurance for my entire family, or can I purchase it just for my son?

GREENE: Julie, what's the story here?

ROVNER: That's right. We really haven't talked about dental coverage much. And it's a very important benefit to a lot of people who haven't had it before even if they have had health insurance. Dental care can be very expensive. If you have untreated dental problems, it can lead to all sorts of other health problems.

Now, this is a place where the people who designed the benefits decided to kind of split things up. We've heard a lot of complaints about there being too many benefits in this minimum package, which has driven premiums up. For that reason, only dental coverage for children is among the required benefits. But in most places you can buy either an add-on package or a separate dental plan if you want to cover adults in your family.

So the answer to Ms. Rowland's question is that assuming her son is a child and not an adult son, yes, she can purchase dental for just him. In fact, any plan on the exchange will cover his dental. She'll have to specifically add dental coverage for the adults in her family, if she wants it.

GREENE: If her son is a child, that will be required under the law - for him to have dental coverage.

ROVNER: That's right. [POST-BROADCAST CORRECTION: Not all states include dental coverage for children in health plans, and people will not be penalized if they don't buy dental coverage.]

GREENE: All right, Julie, another question. This one comes from Juneau, Alaska; from George Elgee.

GEORGE ELGEE: And my question is, can employers pay for insurance that employees buy on their own, from either from the exchange or private people?

GREENE: OK. The answer?

ROVNER: Well, it sounds pretty straightforward. It turns out Mr. Elgee is a CPA, and what he really wants to know is whether employers, particularly small employers, can basically reimburse workers who buy their own insurance, and then the employers would get a tax deduction for it. It seems the answer is probably not.

Now, there are lots of provisions in the law to encourage small employers to purchase coverage directly for their workers. There's a new tax credit for very small employers who have mostly lower-wage workers. This year, it's set to cover 50 percent of the cost of coverage. Then there's something called the shop exchange, where businesses are supposed to be able to go to get a better choice of plans for their employees.

The problem is that with the rocky rollout of the websites serving individuals, both the federal government and most of the states have really kind of put the small-business part of the program on the back burner. And where it is operating, it hasn't had a lot of traffic; and the few businesses that have tried to use it say they've had some trouble. So at least for now, that part of the program really isn't living up to its expectations.

GREENE: And you've actually reported on that; how some of the parts of the law dealing with small businesses are really being pushed aside for a while.

ROVNER: Yeah. And that may be why for now, some small employers just want to give their workers some extra money, and let the workers buy their own coverage. But in talking to tax experts, they say that may not be the best way to help their workers. That's because the higher a person's income, the less help they get paying for their premium and - in terms of those subsidies. So if an employer really wants to help, they might want to put more money into a worker's retirement plan - if they have one - or buy them, maybe, vision or dental benefits.

GREENE: All right, some answers for now. But I think it's safe to say, you and I will be back here soon with more questions and answers.

ROVNER: Indeed.

GREENE: NPR's Julie Rovner. Thanks a lot.

AMY ROWLAND: Thank you.

GREENE: And if we didn't get to your question today, we have more questions, more answers in a searchable app that's on our website. Just go to And if you don't find your answers there, you can also send your questions to


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