Kids' Dental Plans Cost Extra in Obamacare Marketplace

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By Julie Small, KPCC


After listening to comments from interested parties ranging from insurance executives to children's health advocates, the board of Covered California voted to hold off making changes to the types of children's dental coverage they will sell starting Oct. 1 in the new marketplace.


The board of California's new health care exchange meets Thursday in Sacramento. On the agenda is what kind of children's dental coverage to offer under the Affordable Care Act. Covered California is required to sell pediatric dentistry plans, but the exchange has made those plans an optional extra.

While pediatric dental care is an Essential Health Benefit under the Affordable Care Act, there's a big exception.


The law allows state-run health care exchanges to sell medical insurance without pediatric dental care as long as they also sell stand-alone plans. The federal law made that exception because nearly all people who have dental insurance today have stand-alone plans. This way they’ll be able to keep their same dentists, even after federal reforms take effect.

But Covered California went a step further and chose to only offer stand-alone dental plans for children and make the purchase optional.

That decision drew the ire of consumer advocates who say parents will have to pay more for their children’s dental care. There are concerns parents may opt out entirely.

“Hopefully it won’t be a big black eye,” said Betsy Imholz with Consumers Union.
While they will discuss the issue today, the board of the exchange has told advocates it’s probably too late to reverse the decision for this year.

“Basically what the exchange did was to tell qualified health plan bidders on the medical side that they could not include pediatric dental," Imholz said. "Some wanted to. Some were ready to. Some weren’t, but as it stands now the only bids they’ve got don’t have the dental as a part of it.”

Imholz and other advocates say offering children’s dental care only as a stand-alone policy will push up the cost for as many as 250,000 children who are expected to get insurance next year through the exchange.

Imholz says families will have to pay from $10 to $30 extra a month for dental care for each of their kids. “If you’re really watching your budget," she notes, "and just barely making rent and food, health insurance could be tough to pay for.”

Families that purchase stand-alone dental care will also have to pay a separate deductible from their medical deductible, and fulfill a separate out-of-pocket maximum.

But Covered California spokesman Dana Howard says its approach could actually benefit consumers.

“It depends on how you look at it," he said. "You can slice it and dice it in whole different ways depending on each individual’s particular scenario.”

Howard says a stand-alone dental plan enables parents to hit a $1,000 out-of-pocket maximum sooner than if the coverage was included in a comprehensive health plan, where that maximum is more than $12,000 for a family.

“You could easily reach your maximum out-of-pocket maximum of a thousand dollars or so for your dental coverage, and then you’re done!”

Pediatric dental care need is great

An estimated 1.1 million children in California lack dental insurance and often go untreated until their problems are so severe they require hospitalization.

“An infection in the mouth can affect the entire body,” explains Dr. Elizabeth Johnson, who treats hundreds of children a year at the WellSpace Health dental clinic in Sacramento. “We see children with infection, decay and abscesses in almost every tooth by the age three, from neglect.”

The California Society of Pediatric Dentistry reports that tooth decay is the most prevalent childhood disease. More children miss school because of dental pain than any other reason.

WellSpace's Clinic administrator Tanya Burgos says it’s often schools that get parents to make an appointment because the child is in so much pain they cannot sit in their chairs.

But Burgos says the issue is not one of parent neglect, it's more a matter of money.

“When you ask parents 'Why haven’t the kids been to the dentist?' they say they don’t have the insurance," Burgos says. "They’re either between jobs or waiting for coverage to kick in or they just couldn’t afford it.”

Nearly all the clinic’s patients are on a state subsidized health program called Denti-Cal. WellSpace Health enrolls eligible children who come to the clinic for care. Those that don’t qualify pay a sliding-scale fee based on income.

Burgos thinks including pediatric dental care in all insurance plans would “definitely make it more accessible for families to get care for their kids and make sure that they are seen in a timely manner.”

Dr. Sharine Thenard, a  pediatric dentist in Alameda, said she’s not so worried about the exchange’s choice to offer stand-alone plans.

To her -- and to many child health care advocates -- the bigger problem is that parents who purchase insurance through the exchange can opt-out of dental insurance for their kids.

“If you don’t mandate the families to buy it," she says, "then it’s the first thing that gets chopped off their list. Because they think it’s just a disposable kind of thing. They think, ‘I’m just going to save a few bucks and I’m not going to get the dental portion of it.’”

The board of California Covered could address that problem by making pediatric dental coverage mandatory next year or in the future.