Health Care and Dental in Health Reform

Now that the new health care legislation is the law of the land, health care companies and businesses everywhere are scrambling to make sense of the thousands of pages that make up the bill. One major consideration for people to decipher is about dental care. So far the analysis indicates that, except for children, dental benefits are largely unaffected. One of the concerns was the essentially high cost tax or the tax on Cadillac health programs that was considered that it might apply to dentistry, according to TheWealthyDentist.com. People are still wondering a bit about how much impact and how involved dentistry will be.

The National Association of Dental Plans indicated that it believes that the standalone dental and vision plans will not be taxed. So what that would mean for the individual as that they wouldn’t be taxed on those benefits that they got which allowed them to purchase how purchase dental services. That’s good news for dentistry relative to standalone dental insurance plans like Delta Dental Program or any other dental program that is viewed as an independent product and it’s not part of a medical plan. The great news is that discount dental plans, like Careington, will likely be unaffected as well. The national health program as it’s conceived really focuses on dentistry for children. It will be interesting to see whether these dental benefits will go to people other than children.

According to Worldental.org, the provisions contained in the health care reform legislation expand access to dental care for children and families and seek to strengthen the oral health of all Americans while working to promote early and effective prevention. Among the provisions directed specifically at improving America’s oral health are:
- Expanded dental coverage. A significant investment in ensuring access to public and private dental coverage for children in America.
- Prevention. Dental disease prevention initiatives including public education, school-based sealant programs in all 50 states and research grants to improve the prevention and management of tooth decay in young children.
- Tracking and monitoring. Resources for the Centers for Disease Control (CDC) and other federal agencies to assess American’s oral health and dental care with a special emphasis on pregnant women.
- Workforce development. Expanded education of dental professionals and those who train and educate future dental caregivers in rural areas and among underserved populations. Grants to allow study options for new dental care providers.
- Safety net improvements. Support for dental programs in school-based and community-based health centers. Creation of a new commission to study oral healthcare workforce capacity.
- Infrastructure improvements. Support for states to bolster their dental public health programs through leadership development, oral health data collection and interpretation, and best use of science to improve oral health.
- Medicaid and CHIP. Expands Medicaid coverage and increases Federal government’s contribution to Medicaid in all states, extends the CHIP program for five years, and addresses payment to dentists and other healthcare professionals through the Medicaid and CHIP Access and Payment Commission (“MACPAC”).

The legislation also recognizes dental hygienists as primary oral health providers through the inclusion of dental hygiene providers, students, and education programs as eligible entities for workforce development funds, according to the American Dental Hygienists Association (ADHA). Additionally, the legislation provides for 15 demonstration grants to train or employ alternative dental health care providers to evaluate emerging workforce models that improve access to oral health care. Public health dental hygienists, independent dental hygienists, advanced practice dental hygienists, and dental therapist models are listed models eligible for the grants.

Also, the addition of pediatric dental coverage under health reform acknowledges the connection of oral health to overall health, according to PrudentPressAgency.com. In effect, children’s dental services will be required to be offered through state health insurance exchanges. Additionally, the legislation recognizes the special value of stand-alone dental plans by allowing those seeking coverage through an exchange to purchase their children’s dental benefits separately from dental carriers that have decades of experience designing and administering dental plans. Given a choice, most employers purchase dental insurance from a stand-alone dental carrier, and many individuals likewise prefer dental benefits offered by specialty carriers that focus on dental. Allowing people to select stand-alone dental coverage ensures transparency and is consistent with the current market, where about 97 percent of dental coverage is provided through policies that are separate from medical plans. In future years, as the new essential benefits requirements are applied outside of insurance exchanges, refinements will need to be made to ensure that stand-alone dental plans will continue to be available alongside medical plans. Failure to make these clarifications could result in an unnecessary disruption of dental coverage for millions of families.

Deemed by the U.S. Surgeon General a "silent epidemic," dental disease remains the most common childhood disease, disproportionately affecting those from low-income families who lack access to adequate care, according to News-Medical.net. The provisions contained in the health care reform legislation expand access to dental care for children and families and seek to strengthen the oral health of all Americans while working to promote early and effective prevention.

Apparently, dental plans will be available through several options in the new health care legislation. According to Delta Dental of Iowa, although complete information is not yet available, a preliminary review offers the following points regarding some of the key provisions affecting dental plans and our customers:
1.) First, from a stand-alone dental benefit plan perspective, it appears that a great deal will stay the same, especially for companies with more than 100 employees. In the short-term, stand-alone dental benefits are not subject to most of the immediate insurance reforms enacted by the new law, such as no lifetime or annual maximums, and the extension of dependent child coverage to age 26. Many of the reforms and health benefit mandates contained in the new federal legislation target individuals and employers with 100 or fewer employees. Some of the reforms are effective immediately or within 6 months, and others are effective beginning in 2014. Larger employers governed by ERISA are also subject to most of these changes.
2.) For smaller employers, the legislation's impact on dental begins in 2014. Individuals with existing coverage and enrolled in a health benefit plan on the date of enactment (March 23, 2010) are "grandfathered" and subject to some, but not all of the insurance market reform changes. Generally speaking, smaller businesses and individuals will become subject to new benefit mandates as defined by an "essential health benefits package." Under the mandates, groups with fewer than 100 employees will be required, among other things, to provide dental coverage for children up to age 21. Essential benefits can be purchased inside or outside a state - or regionally - administered health exchange. These benefits must conform to an assortment of new market reforms including no annual or lifetime maximums, no copayments for some services, and an annual out-of-pocket maximum of $5,000 when combined with medical costs.
3.) Details about the applicability of these market reforms to stand-alone pediatric dental plans will likely be written by the Secretary of Health and Human Services and are, as of now, unknown. Additionally, the final children's dental benefit plan design is not yet defined. Within the exchanges, individuals and smaller employers will be allowed to purchase stand-alone pediatric dental coverage from companies, in combination with essential medical benefits. Yet, clarification is needed to assure the same choice will be available to smaller businesses and individuals opting to purchase benefits in the private marketplace. In future years, larger employers will also have access to plans available through the exchanges.

Planning for dental benefits and taking advantage of the best plan designs are where companies and individuals should focus for this health care need. Although quite alot of what will take place with the new legislation still needs to be sorted out, dental costs certainly will not be on the decrease. Using reliable companies who provide dental services is key, and managing costs is paramount to receive maximum care for minimal expense. There are very good plans now in the marketplace including both dental insurance and dental discount plans. Based on your needs, explore the value of both before deciding to choose a plan for your oral health expenditures. If you are looking at either alot of work to be done, or just limited dental hygiene and dental maintenance, there are very good plans that are available to fit your budget.

According to ProducersWeb.com, the growing evidence linking oral health to overall health, and consumers' awareness, provides a great opportunity for carriers, health care purchasers and consumers (and, yes, even politicians) to reprioritize and reposition dental benefits so that everyone can afford dental care and maintain better overall health. All this news about dental care’s importance provides agents, employers, and individuals their own opportunity. Whether presenting new dental plans that can help groups reduce their medical plan costs, or bundling discount dental plans to stretch benefit dollars in an HSA-type individual medical plan, selling the benefits of affordable dental care has never been easier — or more important.

Until next time. Let me know what you think.