The American Academy of Pediatric Dentistry is sounding the alarm that many children aren’t getting the dental care they need — even though the Affordable Care Act included pediatric dental care on its essential health benefits roster for plans offered in the small-group market.

This health problem, along with the complexity of the ACA’s impact on dental coverage, give brokers an opportunity to help employers get a grip on their needs as they begin planning for 2015. 

See related: Be wary of this ACA landmine

A condition called early childhood caries — a rapid form of tooth decay — is the most common disease faced by young children, “and it’s on the rise,” concludes an AADP report titled, State of Little Teeth. “Research shows that ECC can cause lasting harm to a child’s oral and general health, and social and intellectual development,” the authors write.

Although health plans subject to ACA’s essential health benefit requirements cover pediatric dental, the deductible structure might discourage parents from utilizing some of those benefits. Also, the least expensive health plans may only cover the dental benefits for children; parents will need to purchase standalone coverage if they decide to obtain that protection for themselves.

Standalone dental plans purchased on the public exchanges during the initial enrollment period only covered 63,448 children, according to a Kaiser Health News report. Health plans sold via the 36 federally managed public health insurance exchanges were not required to include pediatric dental coverage this year. Only 26% of health plans featuring family coverage sold through those exchanges included pediatric dental benefits, according to the Kaiser report.

A Kaiser analysis of standalone pediatric dental plans found a wide range of costs from state to state. For example, a low-option plan was available in one county in Utah for $8 per month, and the same plan cost $33 for a county in North Carolina. Deductibles also varied. The national average monthly charge for low-option plans was $21, and $27 for high-option plans, according to a Kaiser analysis of U.S. Department of Health and Human Services data.

The ACA establishes ceilings on out of pocket expenditures for pediatric dental plans. This year the limits were $700 for a plan covering only one child, and $1,400 for plans covering more. Next year those limits will drop by half, to $350 and $700, respectively.

Stolz is a freelance writer based in Rockville, Md.

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