How will health reform affect dental coverage?

Much of the attention over what changes federal health reform will bring has focused on doctor visits and hospital stays. But what about dental care?

Tequila Terry, director of plan and partner management for the Maryland Health Benefit Exchange, addresses what is coming when the Affordable Care Act, also known as Obamacare, becomes effective Jan. 1.

How will access to dental care change under health reform?

The Affordable Care Act created a concept called essential health benefits, and that requires certain categories of health care to be included in all plans offered to consumers. Pediatric dental coverage is now a requirement for private insurance plans. On the exchanges [marketplaces for buying insurance formed under the law], this can be offered through medical insurers or stand-alone dental companies or a combination of the two. There will be a variety of ways they will be able to offer those services. ... In the state of Maryland, we went about defining our pediatric dental coverage by doing the benchmarking process that the Department of Health and Human Services defined. We looked for specific examples out of a menu of different types of plans that were being offered in the state to create what's called a benchmark, that would essentially establish the minimum amount of coverage offered in plans on the exchange. As part of that exercise, we opted to select the Medicaid dental plan as the benchmark, since it had a very robust set of benefits for children.

But Maryland made the decision [that] we are also going to offer adult dental services. Although there won't be subsidized adult dental coverage, we think it's important to offer affordable adult dental coverage through the exchange.

What sort of options will consumers have?

What we'll be able to offer in Maryland will be a combination of medical plans that embed dental and stand-alone dental plans. There will be a lot of ways people can choose a plan that is most appropriate for them. On the individual market, there will be dental plans from CareFirst, Delta Dental, DentaQuest, Dominion Dental and United Concordia. When we go to launch the SHOP [Small Business Health Options Program, an insurance exchange], there will be even more options for dental coverage.

What will be covered?

[The essential health benefits] are the minimum coverage that's allowable. Insurance companies can opt to offer more, but at a minimum, they have to offer what's included in the Medicaid children's dental plan. That plan is called Maryland Healthy Smiles and is one of the most comprehensive plans offered in the country. [Maryland Healthy Smiles covers services including cleanings, X-rays, root canals, crowns and medically necessary orthodontics.]

Do the changes apply only to the exchange or to insurance purchased outside of the exchange as well?

The requirement to have or offer dental coverage is the same inside and outside the exchange. Outside the exchange, medical plans embed dental coverage.

The Baltimore Sun will occasionally run questions and answers concerning the Affordable Care Act's implementation. If you have a question, email healthsci@baltsun.com for consideration.