Tag Archives: Dental health

What must issuers of pediatric dental benefits consider with AV ranges gone?

The draft Notice of Benefit and Payment Parameters for 2019 was published in October 2017. In this rule, there is a significant change affecting dental benefit plans—removing Actuarial Value (AV) requirements for Patient Protection and Affordable Care Act (ACA)-compliant standalone pediatric dental plans. This change in policy provides new flexibility for dental issuers and closer alignment of pediatric dental benefits between standalone dental plans and pediatric coverage embedded within an ACA medical plan.

In this paper, Milliman consultant Joanne Fontana discusses this change and why it will be critical for dental issuers to understand and act on as the 2019 pricing cycle starts.

How might healthcare reform 2.0 affect dental care benefits?

The Patient Protection and Affordable Care Act (ACA) made pediatric dental care an essential health benefit that issuers must offer on state exchanges. If proposed changes to the ACA are enacted, the dental benefits industry must again determine how to proceed in an evolving landscape. In this paper, Milliman’s Joanne Fontana discusses several key components of the ACA that, if amended or removed, would affect dental benefits. She also provides considerations for dental insurers that can turn another potential round of reform into opportunity.

More access to pediatric dental care could increase health exchange premiums

Starting in 2014, the Patient Protection and Affordable Care Act (PPACA) will provide children greater access to dental care. Pediatric dental care is among the essential health benefits that new health plans must cover within health exchanges as well as individual and small-group plans under the law.

Citing Milliman research, this Washington Post article discusses out-of-pocket maximums associated with these new health plans that make dental benefits richer. Out-of-pocket maximums would curb the cost families incur for expensive dental services compared to annual or lifetime limits.

Here is an excerpt:

Evelyn Ireland, executive director of the National Association of Dental Plans, says families who need expensive dental care such as braces may fare better in dental plans sold on the exchanges than in the plans many employers currently offer.

Nationwide, medically necessary orthodontia costs roughly $6,500 per person, Ireland says. Currently, if a private dental plan covers orthodontia, the benefit typically covers 50 percent of the cost, up to a lifetime limit of $1,000 or $1,500. “So it ends up basically being a down payment,” she says.

Assuming braces are a covered benefit, the family of a child with dental coverage through an exchange might have to pay the maximum out-of-pocket limit – $1,000, perhaps – and owe nothing more that year for the child’s dental care. But any other expenses would be covered, since plans can’t have dollar limits on coverage.

That unlimited coverage will probably add to the premium for pediatric dental coverage, however.

Ireland’s group asked the benefits consultant firm Milliman to estimate how much pediatric dental premiums might change if the coverage provisions of the law were incorporated.

Milliman estimated that premiums currently range from $21 to $25 per child per month, depending on whether a plan covers orthodontia services, among other things. After incorporating the health law’s requirements, Milliman projected that premiums would probably rise to $34 a month, Ireland says.

“That’s a nine-dollar-to-13-dollar-a-month jump, which is a pretty significant increase for a family,” she says.

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

Healthcare reform: What about dental?

While many of the tenets of the Patient Protection and Affordable Care Act (PPACA) focus on medical insurance, its implementation will also have a major impact on how dental insurance is offered, what services are covered, and the cost of dental coverage.

The inclusion of “pediatric services, including oral and vision care” as a required coverage in the essential health benefit (EHB) package creates an interweaving of medical and oral health services rarely seen prior to healthcare reform, causing new complexities in selling and administering dental insurance.

As the PPACA is implemented, it will be critical to consider the inclusion of dental insurance thoughtfully in order to prevent unintended consequences to the dental insurance marketplace affecting insurers, consumers, and providers alike.

For more on this, read the new healthcare reform briefing paper.

Don’t forget your teeth

An op-ed by the dean of the NYU Dental School asked that dental care not be left out of healthcare reform. Dental care is often overlooked (kind of like flossing), but it does have larger health implications than just what goes on in your mouth.

A recent white paper by Darcy Allen, George Berry, and Rob Pipich outlines the case for integrating dental care as part of the larger view of a patient’s health. While some insurers have started to recognize the symbiotic relationship between dental health and general medical health, few have taken advantage of it. Regardless of merit, dental health is perhaps a longshot as a healthcare reform priority.