Dental Benefits and Health Insurance Marketplaces: An Update on Policy Considerations

The Affordable Care Act (ACA) includes pediatric dental services as one of ten Essential Health Benefits that health plans in the small group and individual markets must cover. Adult dental services are not required, but are being offered by marketplace plans as well. However, the way that the ACA structures dental coverage has created a number of implementation challenges relating to affordability, benefit design, and consumer experience.

In 2014, the National Academy for State Health Policy (NASHP) examined these issues in a comprehensive report. In early 2015, NASHP convened a follow-up call with marketplace and dental leaders to discuss progress on addressing these issues.

This brief provides an update of current activity across the marketplaces. Key issues addressed include:

  • Impact of decisions to offer pediatric dental coverage through medical plans or stand-alone dental products on affordability and implementation of marketplace systems;
  • State interest in offering optional adult dental coverage;
  • Enhancing data and reporting on access to and purchase of dental coverage;
  • Improving outreach, enrollment, and dental plan quality;
  • Impact of future state and federal decisions about coverage programs on dental coverage through marketplaces, including decisions about federal funding for the Children’s Health Insurance Program (CHIP).
Read full brief here