Adult Dental as an EHB?  NADP Reviewing Proposed CMS Rule

November 29, 2023

NADP is reviewing the U.S. Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2025 Proposed Rule published Nov. 15. The rule proposes allowing states to add routine adult dental benefits as an essential health benefit (EHB).

The Centers for Medicare and Medicaid Services (CMS) proposes to remove the regulatory prohibition on issuers from including routine non-pediatric dental services as an EHB, allowing states to add routine adult dental services as an EHB by updating their EHB-benchmark plans. Removing the prohibition on routine non-pediatric dental services as an EHB would remove regulatory and coverage barriers to expanding access to adult dental benefits. This proposal would also allow states to improve adult oral health and overall health outcomes, which could help reduce health disparities and advance health equity since these health outcomes are disproportionately low among marginalized communities. Under this proposal, states would be permitted to include routine non-pediatric dental services as EHB for their ABPs or BHP standard health plans.

For more information contact Government Affairs Analyst Bernice Ogbondah.