You probably have read this statistic – 60 percent of children in the United States will have cavities by age 5. In 2012, the Centers for Disease Control and Prevention announced that the number of preschoolers with dental caries was on the rise after several decades of declining numbers.
Research demonstrates that children with dental problems struggle to focus on learning in school. Annually, children lose over 51 million school hours due to dental pain and illness. Medical professionals report that children in this group are more likely to have ear and sinus infections, and are at increased risk of developing other chronic medical problems, such as obesity, diabetes and heart disease.
Pediatric dental coverage and the Affordable Care Act Children's dental issues were on the minds of lawmakers as they crafted the Affordable Care Act (ACA). The ACA requires medical plans within the public exchanges to offer a group of Essential Health Benefits that includes dental benefits for children, typically up to age 19. Exchanges can offer stand-alone dental plans for children if the major medical plans don't offer dental benefits, according to the U.S. Department of Health and Human Services.
As of January 1, 2014, medical insurers were obligated to offer Essential Health Benefit packages to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. Larger employers offering benefits to employees have until 2015 to meet the ACA employer-mandate insurance obligation.
Value of consistent dental coverage In March 2011, the American Dental Association determined that 10 million children age 2 through 18 did not have dental coverage. Health professionals projected that parents and caregivers of many of these children would purchase plans with pediatric dental coverage through federal or state exchanges.
Open enrollment for the exchange marketplace closed March 31, 2014. And although medical plans subject to the ACA's Essential Health Benefit requirements do cover pediatric dental, health experts are concerned that the deductible structure may have discouraged parents from purchasing pediatric dental coverage.
Both adults and children need regular dental care to maintain good overall health, and there are dental plan options available to help meet their needs.
Stand-alone dental Stand-alone dental plans, which can be purchased separate from medical plans, offer comprehensive coverage for children and adults. Plans cover everything from preventive services to more serious dental procedures. Currently, 98 percent of Americans with dental coverage have a dental policy separate from their medical policy.
Stand-alone dental plans typically are offered by carriers that are experts in dental, which means
- Premium costs are accurate
- Benefits can be customized to meet employer and employee needs
- Customer service and claims processing systems are likely to be designed specifically for dental
- Some carriers also have a nationwide, credentialed provider network
Dental within medical plans When considering a medical plan with dental coverage embedded, it's important to understand how the plan is designed, along with the carrier's expertise with dental coverage and claims processing.
Design – The medical plan may cover preventive care for cleanings and checkups but feature a high deductible that must be met in full before medical or other dental services will be covered. This means that families with dental needs, such as fillings, crowns or root canals, may face large, unexpected bills. Experience indicates that families in this situation may decide to delay care, resorting to dental urgent care centers or hospital emergency departments if the pain becomes intolerable.
- Dental coverage within a medical plan may cover only medically necessary orthodontia, such as cleft-lip conditions. This means kids enrolled in an orthodontia plan to repair crooked teeth and bite problems no longer will have coverage.
Claims processing – People who have dental benefits tend to use them. Medical plans with dental coverage may struggle to process claims accurately and quickly, because their administrative systems are not set up to handle the unique requirements of dental claims.
Carrier expertise – Developing a pricing structure for dental coverage requires extensive experience to design the plan and set a predictable premium that employers and employees can rely on for budgeting. Many carriers offering dental don't have the expertise to price coverage accurately. They may initially price plans low and then have to raise rates to cover unanticipated costs.
Recognizing all family members' needs Adults who purchase pediatric dental plans will need to purchase coverage separately for themselves and their dependents age 19 and older. Within a family, there could be different needs for dental care:
- Dependents age 19 and older may have special dental needs or may wish to purchase teeth whitening coverage in addition to routine dental exams.
- Adults may notice changes in their oral health as they age, which may require services beyond preventive care to help them enjoy good overall health in their senior years.
- Children may need additional dental coverage for special needs, including cosmetic orthodontia.
Families need flexible dental coverage that can be customized to their specific needs. With dental insurance they are likely to schedule regular checkups and exams, so doctors can evaluate the health of their teeth and develop the right treatment plan.
Meeting family dental needs Americans of all ages have dental needs. It is important to focus on children's oral health since baby teeth lay a foundation for dental and medical health throughout life. Adults also should be reminded of the value of taking good care of their teeth and gums to avoid developing serious medical conditions. Having a mix of dental insurance options is essential so employees can choose the plan that best meets their family members' needs.
Producers and employers can help employees understand the value of dental coverage, as well as the wisdom of paying a small monthly fee for insurance to protect their health and that of their family.
Visit www.ameritasgroup.com for more information and to find an Ameritas representative in your area.
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