The Connect for Health Colorado health care marketplace opens on October 1. In addition to medical insurance, pediatric dental is one of the required benefits called Essential Health Benefits under the Affordable Care Act (ACA). To ensure that children have access to dental coverage as early as possible, the ACA includes pediatric dental benefits as part of individual medical benefits. Purchasing a stand-alone dental plan either on or off the exchange can also satisfy the pediatric dental requirement.
If you are planning to purchase pediatric dental coverage through the exchange, one of the biggest decisions you will face is whether to choose a stand-alone dental plan or an embedded plan that combines health and dental.
Of course, you will need to consider your child’s dental needs when evaluating plans, but, in general, stand-alone products deliver more value.
When you purchase an embedded dental benefit, the amount you pay for coverage is based on deductibles and out-of-pocket maximums determined by the medical insurance, which tend to be much higher than they are for dental insurance.
• For example, a deductible for a gold-level health plan is expected to be $2,000 in comparison to a typical deductible for a stand-alone dental plan that ranges from $25 to $100.
• So if you buy your dental insurance embedded in medical insurance that has a $2,000 deductible, and your child needs a dental procedure that costs $500, your insurance coverage will not pay for that service unless your child has already had other services that contributed toward the deductible.
• On the other hand, with a stand-alone dental policy, you would pay the $25 deductible, and then your insurance coverage would pay benefits on the remaining $475 of your dental bill.
The out-of-pocket maximums for a family medical plan are also much higher, typically around $6,000 for an individual and $12,000 for a family. A stand-alone dental plan will have lower out-of-pocket maximums: $700 for 1 child and $1,400 for a family with 2 or more children.
A family with acute dental care needs will pay a much higher amount out of their own budget to meet the cost-sharing requirements of the medical plan.
For more information, go to What Consumers Need to Know About Health Care Reform.