How the Affordable Care Act is affecting dental and vision benefits

Understandably, most of the attention generated in the health insurance world in the past year has concerned the Affordable Care Act (ACA) and its impact on health benefits. What has gone unnoticed, however, is that the ACA also has had an impact on dental and vision benefits.

“There are many misconceptions about the ACA, especially in terms of how it pertains to dental and vision benefits,” says Ryan C. Wasileski, director of Ancillary Products Operations for UPMC Health Plan. “In general, people don’t realize that the ACA impacts vision and dental benefits and what that means for them.”

Smart Business spoke with Wasileski about dental and vision benefits and how they have been impacted by the ACA.

Is dental coverage required under the ACA?

Yes, for children, but not for adults. Under the ACA, in order for an individual or a small group market plan to be certified as a ‘qualified health plan,’ it must provide all 10 essential health benefits (EHBs). Pediatric oral health services, but not adult oral health services, are considered EHBs.

What are the requirements on dental and vision benefits under the ACA?

Dental and vision benefits sold in stand-alone policies are not subject to most ACA provisions. Only pediatric dental and vision benefits are part of EHB packages, which are required to be offered to individuals and small employers.

There is no requirement, however, that health plans provide dental and/or vision coverage to persons 19 and older. This also means that stand-alone dental plans are not subject to the reforms that impact other coverage.

Can adults keep their same dental and vision coverage?

Employers who have 50 or fewer employees must offer minimum essential coverage. Because employers are not required to purchase dental and vision benefits for their employees via the Exchange, employees can keep their current insurers for those benefits.

However, the mandate that employers with fewer than 50 employees must offer affordable minimum essential coverage or face a fine does not apply to dental or vision coverage.

How common is it for insurers to offer dental care as part of comprehensive health insurance?

Today, an estimated 99 percent of all dental benefits are sold under a separate policy from medical coverage. Only about 1 percent of consumers have dental benefits as part of their medical policies. That is not likely to change, and insurers will continue to offer stand-alone dental plans.

What does it mean that pediatric dental and vision plans must meet EHB standards?

Pediatric dental and vision benefits are included among the 10 EHBs that must be offered by employers. It is possible that adults wishing to have dental and vision coverage will have to purchase it separately.

Why have dental and vision coverage at all?

Good dental hygiene promotes general health. Regular visits to the dentist can tell a dentist more about your overall health, including whether you may be developing other diseases such as diabetes. It is widely believed that the health of your mouth reflects the condition of your body. A healthy mouth suggests a person with good overall health, and poor oral health can be a sign of other health problems.

Vision and eye problems rarely have symptoms or outward signs, so they can easily go undetected. Early diagnosis and treatment can prevent vision loss and help to maintain good vision. Regular eye exams can determine if you need eyeglasses or a new prescription. Adults should have regular eye exams for early signs of eye disease. Eye exams for children are important in maintaining normal vision development.

What is expected to be the impact of the new law on children and dental benefits?

The American Dental Association is predicting that 8.7 million children could gain dental coverage through the ACA by 2018. The number of children without dental benefits could be reduced by about 55 percent. It is estimated that the number of adults without dental benefits will be reduced by approximately 5 percent.

Ryan C. Wasileski is a director of Ancillary Products Operations at UPMC Health Plan. Reach him at (412) 454-6494 or [email protected].

Insights Health Care is brought to you by UPMC Health Plan