IMPACT of PPACA on Dental Benefits

With the passage of PPACA in 2010, a new requirement for coverage of oral health services for children under age 19 will became part of required coverage in the individual and small group market beginning in 2014. There is significant confusion about how the children’s oral services provision is being included in policies. The coverage of 22.9 million children that were covered in the small group market prior to 2014 under separate dental plans could be duplicated in some part by a medical plan that makes pediatric dental benefits subject to the medical deductible or waives that deductible for prevention thereby creating a “prevention only” benefit. For more details on the coverage options under the Affordable Care Act (ACA) use these links to information on NADP’s website: 

  • NADP Infographic: Dental Benefits Choices for Children
  • NADP Issue Brief: Dental in the Marketplaces: Consumer Tips on Shopping for Dental
  • NADP Issue Brief: The Basics of Dental Coverage and the ACA

The Pew Center for the States estimated that 5.3 million children would be added to coverage when the ACA went into effect primarily through public programs like Medicaid and CHIP.

In 2014, only about a half-million children applied for commercial health coverage in state or federal exchanges. It is not known whether these children obtained dental coverage through the health plan that was selected. Only 26,600 selected stand-alone dental plans (SADP) in the federal exchange as seen in the percentages included chart below. As well, while an additional 8 million were enrolled in public programs including Medicaid and CHIP which cover pediatric dental; the percentage of those in the 0-18 age bracket that are new enrollees is not known.

In 2015, the number of commercial applications for medical coverage in the 0-17 age group through state and federal Exchanges increased to 890,017 with about 100,000 of these applying for standalone dental coverage. Again, it is not known whether the other 790,000 obtained dental benefits as part of their medical plan. So clearly any increase in the total number of children with dental insurance would have to be primarily through state Medicaid and CHIP programs.

Trends in Exchange Selections of Coverage 2014-2017

In 2015 about 1/3 of the medical policies offered on marketplaces included a pediatric dental benefit. Of those 90% made that benefit subject to the medical deductible that averaged just under $3000. Of the 90% two thirds waived the deductible for diagnostic and preventive care making the pediatric benefit a “prevention only” benefit.

In 2016 the number of children applying for commercial coverage again increased; it was 1,068,631. Of these 115,304 applied for separate dental coverage. Again, no information was made available as to whether the other applicants obtained medical policies with pediatric dental coverage. About 1.4 million individuals overall applied for separate dental coverage, i.e. primarily adults.

In 2017, the number of children applying for commercial coverage through all public exchanges was approximately level to the prior year, i.e. 1,068,082 vs.1,068,631 the prior year. The number of overall applications in all public exchanges was down slightly as well, 12,200,000 vs. 12,600,000 the prior year. Overall there were about 1.9 million public exchange applications for SADPs with approximately 134,000 of these applications for children in the 0-17 age group.