Obamacare quirk forces people without children to buy pediatric dental insurance


Obamacare has provided health insurance to 10.3 million previously deprived people, according to government data. It also brought in a legal quirk that is no laughing matter.

The confused legal treatment of pediatric dental benefits forces people without children to purchase separate pediatric dental insurance policies that they will never use. And different interpretations of the law by states require parents to take extra precautions to ensure their children receive the dental benefits they need.

I am middle aged and have no children. But when I bought an individual health insurance policy from New York insurer Empire BlueCross Blue Shield, the seller insisted that I was required by law to have a separate pediatric dental policy. So I’m paying $ 4.50 a month – or $ 54 a year – for an insurance policy that doesn’t give me any benefits.

Insurers sell similar policies to adults without children in California, Colorado, Washington, and other states.

Elsewhere, including Connecticut, Rhode Island and the District of Columbia, pediatric dental insurance is built into everyone’s Obamacare coverage, said Colin Reusch, senior policy analyst at the Washington-based Children’s Dental Project.

Including pediatric dental coverage with emergency care, doctor’s visits, and other mandatory health insurance coverage saves everyone money. If New York City incorporated pediatric dental care into my health policy, my total Empire BlueCross premium could drop by a few dollars a month, Reusch said.

The integration of coverage also ensures that children are always covered by their parents’ health policies, he added. This is easier than covering them with separate dental policies like those sold to adults.

But integrating pediatric dental coverage raises another set of issues. Some health insurance policies impose the same high deductibles on pediatric dental services as on other benefits, Reusch notes. This can make a routine trip to the dentist too expensive. Reusch says parents should look for health policies with lower deductibles for pediatric dental care.

Parents should pay attention to the issue if they plan to purchase health insurance when the next open enrollment period for Obamacare begins on November 15.

The oddity of pediatric dental insurance stems from a collision between Obamacare, the traditional state regulation of the insurance industry, and the American tradition of selling dental insurance separately from health insurance.

Pediatric care, including pediatric dental care, is among the basic coverages that all health insurers are required to provide to new enrollees in individual and small group policies under the Affordable Care Act, which is the name Obamacare official. Pediatric dental care is not required for group policies offered by large employers, although insurers generally provide it anyway.

Other coverages are also mandatory under the rules of the Affordable Care Act. Anyone who has purchased an individual or group Obamacare policy is covered for maternity and newborn care, including men and women beyond the childbearing age. Obamacare policies must also include hospital care, mental health and addiction services, and prescription drugs.

Everyone pays for these mandatory built-in covers, even if they don’t need them. Obamacare is insurance, and one of the ideas behind insurance is to share the costs among a large group of people.

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But when it passed the Affordable Care Act, Congress decided that pediatric dental care would be treated differently. The law allows pediatric dental care to be sold separately, like adult dental insurance. Reusch said Congress likely passed the rule to minimize disruption to the traditional dental insurance market.

The law also left it up to states to determine how to provide pediatric dental coverage. So different states have different rules. Some make pediatric dental care part of all Obamacare policies, while others require it to be sold separately.

It’s worse: even within state governments, rules are interpreted in different ways.

In New York City, a spokesperson for the state Department of Health said Empire BlueCross was wrong to sell separate pediatric dental coverage to childless clients like me. But another agency, the Department of Financial Services, contradicted the Department of Health, saying that separate pediatric dental policies may be needed. Empire says he follows the rules of the Department of Financial Services.

What happened in Colorado was stranger. Under state rules, insurer Delta Dental offers special pediatric dental policies to people without children for a monthly premium of $ 0.

Colorado insurers cannot charge childless children more than $ 1.50 per month for separate pediatric dental coverage, “because it’s a no-benefit policy,” a spokesperson for the Colorado Department of Regulatory Agencies.

Some Colorado insurers build pediatric dental care into Obamacare policies, while others sell it separately, said Adam Fox of the Colorado Consumer Health Initiative. “It’s left to the insurers,” he said.

Some states are trying to fix the mess. California will require pediatric dental insurance to be included in all Obamacare policies next year, ending the practice of selling separate policies to people without children.

Until it’s fixed all over, beware of the buyer.

Bill Sanderson blogs about New York area utilities at www.nypowerandlight.com.


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