Kids dental folded into family plans

Insurers selling healthcare via the Obamacare organization in California must offer children’s dental coverage as of 2015.

Pediatric dental coverage currently is offered as a standalone policy via Covered California, at extra charge. As of 2015, it will be embedded in all family healthcare policies, the board decided.

Less than a third of children (27 percent) signed up for health insurance via Covered California also are enrolled for the optional dental coverage, the state marketplace’s executive director said at the Jan. 22 board meeting. “That was a surprise for me,” Peter Lee said.

Children’s dental care is one of the essential health benefits under the Affordable Care Act, but states can offer the coverage separately from the private insurance it sells under Obamacare. Last summer, the Covered California board decided to do that, promising children’s advocates that the decision would be revisited.

The state insurance commissioner and some children’s services activists had criticized the health insurance exchange’s decision not to roll dental care for young people into basic family plans.

It was the second win for children’s dental care advocates in recent days. The state Assembly Health Committee voted to continue the Virtual Dental Home project, under which dental hygienists can examine children at schools and have a dentist review the results via computer networking.

The standalone pediatric care currently offered by Covered California does not qualify for subsidies. Out-of- pocket expenses incurred via the dental do not count toward the general health insurance policies’ maximums.

The standalone plans, nonetheless, will continue to be offered as an option, in theory giving consumers access to more dentists including, perhaps, the ones they currently use.

Lee said of the low enrollment for the standalone care: “A lot of folks are low income. “They’re thinking additional coverage versus food on the table.” Children that qualify for Medi-Cal will receive dental services through that low-income program.

The so-called pediatric dental plans actually cover people up to age 19.

Obamacare does not address adult dental care, although Covered California has said it’ll consider providing that coverage in the future.

Currently 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.

The 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.