Did you know that oral health problems cause children to miss a total of 51 million hours of school annually? Regular checkups with a children’s dentist in Rowlett are crucial for preventing these problems and making sure children have the healthy teeth they need for a great childhood. But navigating dental insurance for kids can be overwhelming, especially because the Affordable Care Act (ACA) has recently changed the way plans are purchased. In this blog, you’ll get a short guide to the basics of how it works to clear up any confusion and help your child get the dental care they need to have a healthy smile.
How Does the ACA Affect Dental Plans For Children?
Unfortunately, the ACA does not mean that children’s dental insurance is free. However, it does require that dental insurance is at least offered when parents are purchasing medical coverage for their children through a health insurance market. In other words, medical plans must either include dental coverage or offer the option to buy it.
But, although it must be offered, it isn’t required, so you won’t pay a penalty for not having it. There are two exceptions: First, in Kentucky, Nevada and Washington, dental insurance for kids is mandatory.
Second, if you buy a medical plan for your child directly from an insurance company (i.e. not through the healthcare marketplace exchange), you must give “reasonable assurance” that you’ll also buy a dental plan. However, some medical plans already include dental coverage, in which case this wouldn’t apply.
Is the ACA Marketplace the Only Way To Get Coverage For Your Child?
There are multiple ways to get children’s dental insurance in Rowlett:
- Through an employer
- Through the health insurance exchange (also called the marketplace)
- Medicaid or the Children’s Health Insurance Program (CHIP)
What Kind of Plans Are Available?
- Embedded – An embedded plan is one plan that automatically includes both medical and dental coverage.
- Bundled – These are separate medical and dental plans that are purchased together from the same insurance provider.
- Stand–alone – These are completely separate medical and dental plans purchased from separate insurance providers.
What Should You Look at When Making Your Decision?
Here’s a short checklist of things to look for, or questions to ask while you’re shopping for a plan:
- First, check to see if dental coverage is included in a medical plan or if it needs to be added separately.
- If you have a preferred children’s dentist, find out if they’re in-network with a plan before purchasing it. You can either check the dentist’s website or give the office a quick call.
- In addition to looking at the benefits and coverage, compare the cost of premiums, deductibles, co-payments, co-insurance and out-of-pocket limits between plans. You can always call the insurance provider if you have questions.
- Also, if both options are available in your state, compare the cost of purchasing an embedded plan versus a separate medical and dental plan to find out which one is more cost-effective.
The ACA has made fairly significant changes to dental insurance for children, but these guidelines will help you complete the process and make the best choice for your family!
About the Author
With 25 years of experience as a children’s dentist in Rowlett, Dr. Tera Pollock knows that dental insurance can be difficult for parents to navigate. That’s why she and her staff do everything they can to simplify it and help their patients get the care they need. Her office is in-network with multiple insurance providers, including Delta Dental, Aetna, Cigna, United Concordia, and Always Care. If you have any other questions, she can be reached via her website or at (972) 475-0301.