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How will healthcare reform affect dental coverage?

September 25th, 2012

By Javier Sanabria

The dental insurance landscape will change in the coming years because of new healthcare regulations. In this article, Milliman’s Joanne Fontana offers perspective on how healthcare reform will affect adult and pediatric dental coverage. Here is an excerpt:

An essential health benefit under the Affordable Care Act, pediatric dental plans will be sold in insurance exchanges, both packaged with adult plans and as stand-alone plans.

“It’s a very, very big shift from the way dental insurance is currently sold,” said Joanne Fontana, an actuary who tracks healthcare and health insurance for the actuarial and consulting firm Milliman. “For the first time, there’s a need for pediatric-only plans.”

State and federal governments still need to decide benefit levels and cost structures for stand-alone dental plans and medical-dental packages, in and outside of the exchanges, Fontana said. A lot of decision-making on exchanges has been left to the states, and a lot of states haven’t even decided if they want to create an exchange, or have worked out the details.

She also discussed the uncertainty associated with new guidelines on cost-sharing limits:

Another uncertainty comes from ACA rules on cost sharing limits for essential health benefits, Milliman’s Fontana said.

Hypothetically, if someone has a medical plan for themselves and his or her child, and has a separate dental plan for the child, somehow the two insurance companies have to co-administer cost sharing limits–a problem without easy solutions, Fontana said.

“If you’re going to administer that, you would have to have claims accumulators going on the medical side and claims accumulators on the dental side that would have to talk to each other,” Fontana said. “For that to happen in reality, it’s just not a pragmatic solution.”

For more information on the effect healthcare reform may have on dental insurance, read Fontana’s paper entitled “Healthcare reform: What about dental?

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