Tag Archives: dental insurance

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.

How will healthcare reform affect dental coverage?

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?