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Better information urged for ACA dental shoppers

March 19, 2013

By Craig Palmer, ADA News staff

Washington—Consumers shopping in the Affordable Care Act marketplace may have difficulty choosing the most appropriate dental benefit product to meet their individual and family needs under current regulatory guidance, the American Dental Association and American Academy of Pediatric Dentistry told federal regulators.

Insurers must offer pediatric dental coverage as an essential health benefit beginning in 2014, but consumers shopping through the new insurance exchanges won't necessarily have to buy it Insurance exchanges are scheduled to begin enrolling beneficiaries for federally subsidized coverage on Oct. 1.

“We support the establishment of a reasonable, separate cost-sharing limit maximum for stand-alone dental benefit plans offering the pediatric dental essential health benefit (EHB),” the dental organizations said. “However, the ADA and AAPD believe that administrative adjustments are necessary to ensure consumers are treated fairly regardless of whether they select dental coverage as part of an embedded dental product or in a separate stand-alone plan.”

As regulatory guidance and proposals stand, consumers may be short-changed on information necessary for informed dental benefit decisions, the professional organizations said in a letter to the Center for Consumer Information and Insurance Oversight, which is charged with implementing many of the ACA provisions.

“We are concerned that consumers will not be provided complete rate information in all cases in time to make an informed choice when considering the selection of a stand-alone dental plan,” said the March ADA-AAPD letter signed by the organizations' presidents.

“The ADA and AAPD support the separately pricing and offering of dental benefits by qualified health plans with embedded dental benefits to ensure consumers have the ability to make informed benefits decisions when accessing coverage in a health insurance exchange. We are disappointed that the [CCIIO] agency has decided this will not be required in states that opt for a federally-facilitated exchange.”

The dental organizations “request clarification that consumers will have access to full benefits information, including cost-sharing, coverage limitations and network participants through the website in order to choose a dental benefit product that meets both their coverage and affordability needs,” the letter said.

Among the main functions of an ACA insurance exchange is operation of an internet website and toll-free telephone hotline offering comparative information on qualified health plans and allowing consumers to apply for and purchase coverage if eligible.