Will Dental and Vision Coverage Change Under the Affordable Care Act?

The Affordable Care Act (ACA) launches in January 2014. Do you know whether it will affect your dental and vision benefits?

Many Americans currently without insurance are looking forward to new benefit choices, while others are wondering how the ACA will impact their lives and the traditional insurance benefits they have enjoyed. Health care reform and the ACA will change the face of medical coverage for many Americans. But here’s the good news: You do not need to make any changes to your dental and/or vision plan, and you can keep your current benefits at least until your 2014 renewal.

As a dental and vision insurance carrier, Ameritas has tracked health care reform since its beginning. And we want to make sure you have the facts about dental and vision coverage in relation to the ACA, so you can maintain the coverage you and your employees need.

Consider these five important truths about dental and vision coverage under the ACA:

    1. You can keep dental and vision plans with a stand-alone carrier. Large employer mandateLarge employers can offer whatever dental or vision benefits they choose. So you can keep the dental and vision plans you have.

      According to new ACA regulations released July 2, 2013, larger employers offering benefits to employees have until 2015 to meet the ACA employer-mandate insurance obligation. The requirement to offer and report on Minimum Essential Coverage (MEC) or pay a penalty was deferred until 2015. MEC does not include dental or vision insurance.

      Small employer and individual requirements. Beginning Jan. 1, 2014, insurers are required to offer Essential Health Benefit Packages (EHBPs) to individuals and employers of fewer than 50 eligible employees that choose to provide benefits. EHBPs include pediatric dental and vision, typically up to age 19.

      Individual mandate. All consumers, with a few exceptions, are required to have medical coverage in 2014, regardless of the size of their employer. If they don’t have MEC, they will be subject to a fine.

      Employers are not required to purchase health coverage for employees and their dependents through a health insurance exchange, which means they may keep their medical, dental and vision benefits with their current insurance carriers.

      Stand-alone plans are a viable option. According to the National Association of Dental Plans, about 98 percent of Americans with dental coverage have a dental benefit policy separate from their medical policy. Dental and vision benefits sold in stand-alone policies are not subject to most ACA provisions. Only pediatric dental and vision benefits are part of EHBPs, which are required to be offered to most individuals and small employers.

    2. Understand Pediatric Essential Health Benefits. Impacts dependents up to age 19. Under the ACA, there are 10 categories of Essential Health Benefits (EHB) that must be offered to most individuals and small employer groups both inside and outside public exchanges, unless the medical plan is grandfathered. One of these categories includes pediatric dental and vision benefits for members up to age 19. 

      In the small employer market, medical carriers must include pediatric vision in their plans. Pediatric dental and family dental coverage can be sold in separate dental policies in most states in or out of exchanges.

      Compare stand-alone dental coverage versus a medical plan with pediatric dental coverage.

      Exchange-certified pediatric dental benefits. Many medical carriers are asking employers to verify that their stand-alone dental plan offers exchange-certified pediatric dental benefits. If not, the medical plan may add pediatric dental. Ameritas offers exchange-certified pediatric dental benefits that can be added to stand-alone plans – now or at renewal. (Plan availability varies by state.)

      Employers can replace the pediatric dental coverage in their current Ameritas stand-alone dental plans with Ameritas exchange-certified pediatric dental. Or they simply may add the exchange-certified benefits and Ameritas will process pediatric dental claims through both plans – traditional and EHB – and pay the better of the two benefits.

      Other key points (in most states):

      • Within the exchange, the medical plan can exclude dental if the exchange offers a stand-alone dental plan providing the required pediatric dental benefits.
      • In the private market, the medical plan can exclude dental if the medical carrier is reasonably assured that individuals have obtained pediatric dental benefits through a certified stand-alone dental plan.
      • No purchase of pediatric dental is required if it is offered in an exchange on a stand-alone basis. This means you can buy your family dental outside the exchange.
      • Traditional pediatric orthodontia coverage may not be available in state exchanges or EHB packages. Currently only orthodontia declared medically necessary (for example, coverage related to a cleft palate condition) would be covered as an EHB. Children currently undergoing a traditional orthodontia treatment program that extends beyond 2013 may be impacted significantly if their coverage is moved to an EHB or exchange plan. Some plans may offer additional options with pediatric orthodontia coverage, but benefits and providers may differ from existing plans.

      Ameritas stand-alone dental plans provide:

      • Dental expertise
      • Dental-focused customer service
      • Accurate pricing
      • Flexible and customizable benefits
      • Claims-paying systems designed specifically for dental
      • Nationwide, credentialed provider network
      • Dental wellness knowledge
    3. Adults need their own dental and vision coverage, too.

      EHBPs from medical carriers likely will cover only members of pediatric age (under age 19 in most states). With these plans, adults would need to purchase dental and vision plans separately for themselves and dependents age 19 and older. This means that family members may have different benefit plans, networks and insurance carriers. By keeping stand-alone dental and vision coverage with Ameritas, the entire family can stay together on the same plan and continue with their current providers.

    4. No flexibility offered in public exchanges for dental and vision. Employers and individuals exploring benefit options through a state exchange or private marketplace should review the plan design carefully to understand the coverage options. Plan choices will be limited, and employers will not be able to customize plans.

      Plans in an exchange may not be cheaper than those offered by an insurance carrier in a private exchange market. Premiums probably will be based on limited criteria instead of utilization trends that are typically used from within an employer’s industry or claim experience. Since insurance carriers will be charged by state and federal administrators to participate in exchanges, these fees likely will be included in the premium costs.

    5. Focus on dental and vision as a wellness benefit. Surveys show that people with dental and vision insurance tend to use their benefits, including scheduling regular checkups and exams so doctors can evaluate the health of their teeth and eyes and develop a treatment plan to address concerns.  

       Employees may think that deferring the purchase of dental and vision coverage will save money, but in reality they may risk developing serious health concerns and incurring significant bills for medical services.

      Employers should help employees understand the value of dental and vision coverage and the wisdom of paying a small monthly cost for insurance to protect their health and that of their family members.

The goal of health care reform is to extend benefits to more Americans for better health. At Ameritas, that’s been our mission all along. For more information about Ameritas dental and vision plans, contact Michael Scheetz at mscheetz@ameritas.com or an Ameritas representative in your area. For updates on the ACA, visit www.ameritasgroup.com/reform


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