The Affordable Care Act requires health insurance marketplaces to offer pediatric dental benefits to all consumers, whether or not a consumer has children. Dental benefits for adults are not required, but some health plans may offer them. There are also stand-alone dental plans available in every state, some offering only pediatric dental benefits while others offer family services.
Currently confusion reigns concerning dental benefits offered by various plans. Ambiguous information about medical plans with embedded pediatric dental benefits and about stand-alone dental plans as well means it is virtually impossible for consumers to make informed choices about which plan to buy.
Among medical plans with embedded pediatric dental benefits, 34% do not have a separate dental deductible which means the consumer will have to meet significant medical deductibles before receiving any dental benefits. One recent study reported consumers in this group might have to meet an annual deductible of almost $3,000 for other healthcare services before receiving any benefits toward dental care.
This is a typical example of the lack of transparency and limited information available to potential buyers of healthcare insurance. Many national and state professional dental organizations are working to improve transparency of dental benefit plans, but no action has yet resulted in clarification of what is available in various marketplaces or how one plan compares to another.