Standalone dental plans would have the same cost-sharing limits and restrictions on annual and lifetime limits as qualified health plans under rules issued yesterday by the U.S. Department of Health and Human Services (HHS) regarding mandated pediatric dental coverage under the Affordable Care Act (ACA).
The rules also require standalone dental plans to offer child-only plans in the insurance exchanges.
The final rules governing how states should set up insurance exchanges and qualified health plans (QHP) cover how Americans can buy essential health benefits, including mandated pediatric dental coverage.
The requirements clarify that families will have the same level of consumer protections, affordability standards, and access to pediatric dental coverage whether they purchase that coverage from a standalone dental plan or a QHP.
"While we wish that everyone in the family will be eligible for subsidized dental coverage, the way the law stands now only children are eligible," Colin Reusch, policy analyst for the Children's Dental Health Project (CDHP), told DrBicuspid.com. "So we want to make sure that families have the option that if they can't afford full family dental coverage, they can purchase the pediatric coverage that will be subsidized."
The actual rules are here (PDF).
So, some questions I have, although I think the Affordable Care Act will no longer be with us by the time 2014 rolls around:
This final rule will implement the new Affordable Insurance Exchanges (“Exchanges”), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.
1. What is covered under pediatric care?
2. Since there are no lifetime caps or limitations, if orthodontics is a covered benefit (subsidized too) how long will treatment be allowed?
3. Who does the government expect to treat all of these newly subsidized children patients?
There will be many more questions and the ones ferreting out the answers will be the dental insurance companies who stand the most to lose financially when and in these rules are implemented.