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Obtaining dental benefits is easy; finding information to compare plans is not

April 21, 2014

By Kelly Soderlund, ADA News staff

Consumers have their pick of dental benefit choices through the new health insurance marketplaces but finding information on covered services is difficult, according to the ADA Health Policy Resources Center.

In their brief, "Health Insurance Marketplaces Offer a Variety of Dental Benefit Options, but Information Availability is an Issue," HPRC authors Cassandra Yarbrough, health policy researcher; Marko Vujicic, Ph.D., ADA managing vice president; and Kamyar Nasseh, Ph.D., economist, analyzed the level of information that is available to consumers when shopping for dental benefits within the marketplace.

The Affordable Care Act requires small group and individual marketplaces to offer pediatric dental benefits to consumers. Dental benefits for adults are not an essential health benefit but some health or dental insurance plans may offer them.

"Our findings provide early insights into how the establishment of health insurance marketplaces under the ACA could affect dental benefits coverage for children, and, ultimately, access to dental care," the authors wrote in the brief. "The fact that there is often limited information available for consumers to make more meaningful comparisons across plans has important implications. With less-than-full information it is challenging for consumers to make optimal choices."

The ACA gives states the authority to customize many key aspects of their health insurance marketplaces, including how pediatric dental benefits are offered which leads to variation in plan types across the states, according to the brief. In some states, all of the offered medical plans include pediatric dental benefits. In other states, none do. Stand-alone dental plans are offered in every state, with some only covering pediatric services and others covering services for a family.

While consumers have a choice, the authors expressed concern about the information available to make that choice. Many of the offered medical plans and stand-alone dental plans have deductibles or coinsurance amounts that apply to preventive pediatric dental services, meaning the consumer has to pay out-of-pocket.

"We feel that this issue needs to be revisited in the next round of health insurance marketplace regulation changes," the authors wrote. "Pediatric dental care is an important component of primary care. But the lack of first dollar coverage for basic preventive dental services for children in some plans could impose financial barriers to care, counteracting the purpose of making pediatric dental benefits an essential health benefit."

Thirty-four percent of medical plans with embedded pediatric dental benefits do not have a separate dental deductible, meaning the consumer will have to meet a higher medical deductible before the plan starts paying for some services. The authors expressed concern that there is a lot of information that remains unclear about the plans, even after more in-depth research.

The researchers acknowledged that some transparency issues are understandable at this point because the marketplaces are so new.

"As these marketplaces continue to evolve, however, effort should be given to improving the information base and presenting dental benefit plan comparisons in a user-friendly, easy-to-understand way," the authors wrote.

Understanding how dental benefits are offered in each state is important because it provides insight into how expanded coverage may increase access to dental care in the future, according to HPRC. HPRC plans to examine how dental provider networks and how different marketplace setups impact consumer purchase decisions and access to dental care.

"As the ACA continues to reshape the U.S. health care system, it is important to generate evidence on these and other issues in the dental care sector to help guide policy."

The ADA continues to analyze the Affordable Care Act and has lobbied for the government to provide more information to consumers about what it offers.

"The ADA made dental plan transparency a centerpiece of our lobbying efforts with regard to ACA implementation, with the goal of ensuring that consumers truly understand what they are buying," said Dr. Carmine LoMonaco, chair of the ADA Council on Government Affairs. "Obviously, many dental products currently offered on the marketplaces fail to meet that test. Greater transparency will continue to be a high priority going forward as ACA 'fixes' are discussed at the national and state levels."