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ACA Basics – Dental Plans in the ACA Marketplace

IRS and NADP Provide ACA Tips

With each passing year, research shows strong relationships between inadequate oral health and a variety of diseases that include diabetes and heart disease.  Those relationships are generally forged beginning in childhood, but may bring a lifetime of consequences.

It is for this reason that the Affordable Care Act lists among its 10 “Essential Health Benefits” or EHBs.  One of the 10 is dental and vision benefits for children, including Pediatric Dental Benefits. The Pediatric Dental Benefits, which cover children up to the age of 19, limits the amount of out-of pocket expenses to the policyholder and has no annual or lifetime limits on cost, are mandatory in any ACA-approved plan.

The situation is different for adults, who are neither required to carry dental insurance nor penalized for not doing so, though a number of medical plans offered through the ACA Marketplace and some state exchanges.

The National Association of Dental Plans (NADP) offers a set of basic tips on shopping for coverage that will meet the requirements of the ACA.  These include:

  • Determine if the dentist you use is on the network
  • Check how the deductible is applied to medical and dental benefits
  • Understand the impact of Consumer Out-0of-Pocket Maximums
  • Examine the definition of Medically Necessary Orthodontia
  • Determine when the Pediatric Dental Premium is eligible for a subsidy
  • Determine whether adult dental plans can be purchased from the Exchange

More detailed information is available from the NADP web site.

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Sources:  Various, including the National Association of Dental Plans at http://www.nadp.org/docs/default-source/eMarketing/NADP_Consumer_Tips_for_Dental_Shopping_In_MarketplacesFINAL.pdf; and Internal Revenue Service at http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision#Minimum Essential Coverage

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