Join ADAMember Log In




Patients' insurance may change under ACA

CMS offers verification guidance

Washington—Dental plans are available in the new Affordable Care Act marketplace and dentists may want to verify patients' insurance status.

"With the beginning of the Health Insurance Marketplace, also known as Health Insurance Exchange, over a million people will have a new insurance plan," said an announcement on verifying patient coverage in the Dec. 30, 2013, provider enews special edition of MLN Connects @cms.gov.

"In many cases, this will be the first time they have had insurance in years," said the Medicare Learning Network notice. "Many of these people will have signed up for their plan within the past few days. They may not have received their card yet or they may be unaware of the need to carry their insurance information. You may find your office needing to verify their coverage."

The MLN Connects notice links to a healthcare.gov data base and a fact sheet on "contacting your health plan's customer service phone number." MLN Connects also offers the following guidance.

"How do you verify their coverage? If the marketplace in your state is run by the federal government, it is best to call their plan's customer service line. A list of all plans and their customer service numbers can be found in this data base [and] here's a fact sheet for using the data base. If you can't find the number, call the Marketplace Call Center (1-800-318-2596).

"If your state has its own health insurance exchange, contact your state. To find the website for your state exchange, select the name of your state in the box at the left hand side of the healthcare.gov website.

"How else can you help your patient? Remind your patients to keep all of their paperwork and receipts from all of their doctor's appointments and from the pharmacy as well. They may need them for their insurer. Remind them they should carry their card at all times. If they don't have a card, they can contact their plan to get a card.

"If the patient is uninsured, they have until March 31 to sign up for non-employer based coverage. They can go to healthcare.gov to sign up for a plan and apply for financial assistance. The vast majority of uninsured will qualify for financial assistance to reduce their costs. You can also download copies of fact sheets or educational material for your patients."

Pediatric and adult dental plans in the new marketplace may be embedded in medical plans or offered as stand-alone coverage. See ACA dental coverage: must offer, may purchase @ ADA.org. ADA members may visit the Centers for Professional Success website for more information.