The Big Bite: Pediatric Dental and the ACA

Turns out, declaring that pediatric dental care is now covered under the Affordable Care Act as an Essential Health Benefit (one of 10 mandated benefits) has more bark than bite. Since the ACA has allowed states lots of latitude in providing this essential coverage, Utah responded by not forcing the medical plans to incorporate pediatric dental into their coverage. Instead, this “essential benefit” is offered as a separate stand-alone dental plan on the Health Marketplace. And since it is sold as a separate stand-alone plan, pediatric dental coverage is not considered “mandatory.” (There is no penalty for not purchasing pediatric dental for your child.) Consequently, in one of those Catch-22 situations, what is “essential” is not mandatory — at least in the state of Utah. What’s worse, these stand-alone plans are not eligible for subsidies or cost reductions, even if there is a subsidy surplus after purchasing a medical plan. Silver Lining: at least these dental plans — which run from $10 to $50 per month and have low if any deductibles — are not embedded into a medical plan’s much higher deductibles, which effectively would result in paying full cost for  dental expenses.

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