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The Patient Protection and Affordable Care Act, often called just the Affordable Care Act (ACA) or, more commonly, Obamacare, is changing many aspects of health insurance, but it’s not really changing much about dental insurance and dentistry.
Pediatric Dentistry Part of Required Coverage
Pediatric dentistry has been included in the list of essential benefits required in all essential plans. These ten categories are:
- Ambulatory patient services
- Preventive care
- Emergency services
- Pediatric care including oral and vision care
- Maternity and newborn care
- Prescription drugs
- Chronic disease management
- Rehabilitative and habilitative services and devices
- Mental health and substance use services
However, the level of coverage varies greatly. In many plans, you may only get coverage for pediatric dental services once you reach your deductible. Insurers are not required to provide cleanings and sealants at no cost to you, so these will still be coming completely out-of-pocket for most people. In some marketplaces, pediatric dental coverage may be offered as a separate plan, and then you won’t be required to purchase it.
Coverage for Adults Not Changing
Obamacare makes no reference to dental insurance for adults, so if you’re an adult, then your dental insurance requirements won’t be changing. According a a spokesperson at the Department of Health and Human Services (HHS), there should be more plans offered that will include both dental and medical care, but since it’s not a requirement, this optional coverage will likely only be found in more expensive plans.
Medicare Coverage Expanding, but Not to Dental Coverage
The ACA includes the expansion of Medicare coverage to include many preventive care services, such as mammograms, colonoscopies, screening for cardiovascular disease, and bone density measurements. However, it doesn’t expand this coverage to include dental services for seniors, such as dentures. Dentures and most other dental services continue to be excluded from Medicare coverage. According to Dr. Ken Siegel of Dental Excellence of Blue Bell in Philadelphia, “This is one of the most backward aspects of the law. It derives from an older concept of medicine that divides oral health from your general health and acts as if dentures were in the same category as cosmetic surgery–a non-essential health care service. Dentures do help people eat, especially modern neuromuscular dentures that fit and function better than traditional dentures.”
Will ACA Result in Improved or Worsened Oral Health?
Some say that the ultimate result of the ACA may be to continue a trend of worsening oral health in the US. For years, employers have been reducing contributions to dental insurance coverage for employees. Combined with the expense of dental care, this has led to many people, especially lower income individuals and those with poor benefits packages through work, to avoid getting dental care until it becomes an emergency. According to the American Dental Association, the number of people visiting the emergency room for dental problems has nearly doubled in recent years and now accounts for more than two million emergency room visits every year. Although it doesn’t have the same level of awareness, the dental health crisis in this country is worse than the general health crisis ever was. Hopefully, something will soon be done to take care of this important aspect of our health.
Matthew Candelaria is a talented writer who received his PhD from the University of Kansas in 2006 and has written hundreds of articles, blogs, and content for websites.