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Members Press Releases Archive

New analysis shows choice of dental policies key to protect families from high out of pocket costs for kid’s dental care

by National Association of Dental Plans | May 19, 2015
National Association of Dental Plans releases infographic that shows how different ACA policies work

DALLAS - A new comprehensive analysis of children’s dental policies typically available both in public health Marketplaces and outside them makes clear that one size doesn’t fit all. A choice in the type of dental plans available allows families to balance the cost of premiums against the out-of-pocket costs for their children’s dental care.

Drawing on publicly available data, the National Association of Dental Plans (NADP) concluded that consumers in the small group and individual markets are best served with a choice between both “embedded” dental coverage – when dental is part of the health policy – and “standalone” pediatric dental coverage, which is offered separately from a health plan, usually as part of a family dental policy in conjunction with a health plan that does not include pediatric dental in its policy.

“Children’s dental needs are best served with a choice in dental coverage because one size does not fit all,” said Evelyn Ireland, executive director for NADP. “Our analysis clearly shows that, depending on the level of care needed, either embedded or standalone dental could be the better choice when considering the combined overall costs of premiums and out-of-pocket costs for dental care. Having choice is critical for families to get the best dental coverage for their children.”

To illustrate the point, NADP released an infographic today that lays out five different scenarios and the corresponding benefit outcomes for children, depending on whether dental is embedded or standalone. “The infographic shows different kinds of ACA-compliant dental plans can result in starkly different degrees of overall patient costs, depending on which scenario is applied,” said Ireland.

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Children’s dental coverage has transformed in the small group and individual market under the provisions of the Affordable Care Act (ACA). While dental was almost always a separate policy before 2014, dental coverage for children today is often embedded in a health policy when offered in the small group and individual market. However, the coverage in policies that embed pediatric dental does not always limit out of pocket costs like standard dental policies. Two key components for families to examine are the application of the deductible and the out of pocket maximum. After the family or child reaches the out of pocket maximum, the medical or standalone dental plan pays all the cost of covered care during the year.

Under ACA rules and regulations, embedded children’s dental coverage can subject all or part of pediatric dental benefits to the health plan’s deductible of several thousand dollars and out of pocket limits up to $6,600 per person and $13,200 for a family. A child or family’s additional health care costs are also counted towards that deductible and out of pocket maximum. With the average standalone dental plan deductible in the $60 -$70 range and out of pocket limits of only $350 per child or $700 per family, the analysis found that standalone dental plans best meet the needs of families whose children have more than basic dental needs.

“Dental benefits with low premium and higher out of pocket costs don’t necessarily meet all families’ needs. Looking at just one cost factor in isolation, such as the premium, can result in a costly mistake for families,” said Ireland. “As Congress grapples with changes to the ACA, the importance of allowing choices where pediatric dental is concerned to meet different needs both inside and outside of Marketplaces is paramount.”

About NADP
National Association of Dental Plans (NADP), a Texas nonprofit corporation with headquarters in Dallas, Texas, is the “representative and recognized resource of the dental benefits industry.” NADP is the only national trade organization that includes the full spectrum of dental benefits companies operating in the United States. NADP’s members provide Dental HMO, Dental PPO, Dental Indemnity and Discount Dental products to more than 177 million Americans, approximately 90 percent of all Americans with dental benefits.

CONTACT:
Evelyn Ireland
Executive Director

(972) 458-6998, x101
eireland@nadp.org