Is there any new dental coverage under the Affordable Care Act? 

Since the implementation of the Affordable Care Act in 2014, there is a new structure for children’s dental benefits. On the public “marketplaces” and for policies sold to small employers of 50 or fewer employees and to individuals, pediatric oral health services are defined as part of Essential Health Benefits (EHB). The pediatric services that meet EHB requirements through a standalone dental plan must meet new AV requirements, cannot have annual maximum limits and must limit consumer out of pocket expenses to $350 a year for one child or $700 a year for a family when the coverage.

While pediatric oral health services in a medical plan also cannot have annual limits, the pediatric oral services that are covered can be subject to the full medical deductible which averaged $2900 in 2015. And the limits on consumer out-of-pocket expenses are much higher under medical plans. In 2017, limits on consumer out-of-pocket spending is $7,150 for an individual medical plan and $14,300 for a family medical plan. Pediatric oral services are included in these limits.

Adult coverage and children’s coverage through large employers (51 and more employees) remains under the structure described under the question, “What do dental plans normally cover?”

Do public programs like Medicaid and Medicare cover dental care? arrow-right

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