The state insurance commissioner and some children’s services activists have criticized the health insurance exchange’s decision not to roll dental care for young people into basic family plans.
The so-called pediatric dental coverage — which actually covers people up to age 19 — will be sold as standalone policies, with separate premiums. Out of pocket expenses incurred for the dental will not count toward the general health insurance policies’ maximums.
In the California health insurance marketplace, rates for children’s dental plans range roughly from $8 to $32 a month. Five companies are providing the coverage.
At an Aug. 8 meeting, Covered California officials said they would reconsider the children’s dental policy for 2015. Dental coverage is not offered to adults in any form but also reportedly is under consideration for 2015.
States have the option of including pediatric dental care under the federal Affordable Care Act, as it is considered an essential health service. The state insurance commissioner, Dave Jones, is pressing Covered California to include the coverage under its basic health plans.
The new plans come organized as dental health maintenance organizations (DHMOs), dental preferred provider organizations (DPPOs) and dental exclusive provider organizations (DEPOs). DHMOs are the most restrictive in terms of choice of dental care providers.
State health exchange officials admitted they should have been more flexible with insurers willing to cover dental for kids: “Covered California should have welcomed bids of embedded, bundled or stand-alone offerings,” an internal report found.
Meanwhile, Covered California said it would not post quality ratings for insurers featured in the debut year of its marketplace.
The exchange originally had expected to implement the quality system in 2014 — two years earlier than required under the Affordable Care Act — but Covered California chief Peter Lee said the health insurer ratings were from 2011 and would be apples and oranges:
“The historic performance of plans may not be representative or complete enough to allow for direct comparisons between plans,” he said.
Federal law requires states to provide quality information for all plans by 2016.
The L.A. Times reported that health advocates and the highly rated Kaiser Permanente chain protested the decision.
Five insurance companies will offer plans to families who buy insurance through Covered California in 2014: Anthem Blue Cross, Blue Shield, Delta Dental, Liberty Dental and Premier Access. (Health Net withdrew from participation in the 2014 pediatric dental plans because of bundling limits.)
Seven companies will offer plans via the Small Business Health Options Program: Blue Shield, Delta Dental, Guardian, Liberty Dental, MetLife, Premier Access and Safeguard.
View the Children’s Dental Insurance plan rates for 2014 (PDF)