Pediatric Dental Coverage Revisited

by George Lauer, California Healthline Features Editor

TOPIC ALERT:

How California children get dental coverage in the new health insurance exchange -- an issue discussed and decided last month -- comes back on the table this week and early next month.

Covered California directors announced plans for offering pediatric dental coverage in stand-alone and bundled plans in June. Children's advocates and the state insurance commissioner are urging exchange officials to include another option -- dental coverage embedded in medical plans.  

The Plan Management advisory committee -- one of three groups offering Covered California advice on setting up the new exchange -- met this week to discuss pediatric dental coverage. The Covered California board of directors scheduled a special session on the issue for Aug. 8.

"We're not sure what it would take to do an embedded plan at this point," said Ellen Wu, one of 15 members of the Plan Management advisory group and executive director of the California Pan-Ethnic Health Network. "It's better for the consumer to offer embedded coverage. We're hoping we can make that an option," Wu said.

California Insurance Commissioner Dave Jones agrees. In a letter to the exchange board, Jones wrote:

"Covered California's decision barring health insurers and health plans from including pediatric dental coverage in the health insurance policy is contrary to state and federal law and will reduce children's access to dental care."

Jones' letter also said:

"You still have the opportunity to make affordable pediatric dental coverage available through Covered California. I hope that you will announce to the health insurers and health plans that had pediatric dental embedded in their health insurance products that they can put it back in rather than requiring them to separate it out."

Two Issues: Mandatory Coverage and What Kind

According to Covered California Executive Director Peter Lee, the issue revolves around two basic questions:

  • Whether to make pediatric dental coverage mandatory; and
  • Whether and how to include embedded plans in the exchange.

In a letter to legislators outlining the issue last week, Lee wrote:

"We believe the Covered California Board has the authority to adopt regulations that would mandate such coverage and exercise its discretion on whether to limit the mandate to families with children. We believe that whatever decision the board makes on this issue, implementation is possible during open enrollment, but unlikely on October 1, 2013."

Consumer advocates argue that dental coverage embedded in a medical plan offers a better, more affordable kind of coverage than stand-alone dental plans.

Betsy Imholz, Plan Management committee member and director of special projects for Consumers Union, acknowledged that timing is difficult and that the dental community is not entirely convinced that embedded plans are a good option

"But we have to try," Imholz said. "From an advocacy standpoint, this is the right thing to do. We think stand-alone dental is not in the best interest of consumers."

The California Dental Association, asked to weigh in on the issue, offered a written statement:

"CDA believes the spirit of the federal law is to require children 19 and under to have dental coverage and we support that. We agree with Covered California that offering stand-alone pediatric dental benefit plans is critical because more than 95 percent of Californians who have dental coverage have it through dental plans, not medical plans. This decision offers the least disruption for families purchasing coverage for their children in the Exchange and will allow parents to maintain their existing relationship with their dentist as the ACA intended."

Four consumer groups last week sent a letter and policy brief to Covered California urging the board to reconsider. They said embedded plans are more affordable, offer better protections and benefits for consumers and will help discourage market distortions.

"We recognize that the hour is late for changes for 2014," the letter said. "It may however still be possible that one or more QHP (qualified health plan) bidders, if permitted to do so, could offer embedded plans, though perhaps not by October 1."

The letter is signed by Kathleen Hamilton of the Children's Partnership, Anthony Wright of Health Access California, Wu and Imholz.

'Time Is Not Our Friend on This'

Consumer advocates acknowledge that making changes for this year's offerings this late in the process may be difficult, but they hope embedded options can be offered in subsequent years.

"Time is not our friend on this," Imholz said. "However, some plans have been prepared to offer embedded coverage so we're hoping that can still happen for this year."

Anne Gonzalez, spokesperson for Covered California, said the special session next month is designed to help staff and board members answer questions of timing and procedure for pediatric dental coverage.

"They are still evaluating all of those options," Gonzalez said. "There are lots of internal meetings going on to present options to the board at this point."

If embedded plans aren't offered this year, advocates said they'd lobby for adding them for future years.

"We might have to re-open up the bidding or at least that part of the bidding could change," Wu said. "If there's not enough time to do it this year, we hope the exchange will offer embedded plans as an option to members next year and in following years," Wu said.

Jeff Album
I for one remain convinced that neither the consumer groups nor the Insurance Commissioner fully grasps how a single, combined medical-dental deductible and out of pocket maximum works to the complete disadvantage of the vast majority of children with this kind of coverage. The issue of mandated versus optional dental coverage is a separate one from that, and easily within the means of the exchange board to solve. Meanwhile, it might perhaps be useful for thoughtful readers to ask, why does 98 percent of today's dental benefits marketplace purchase dental as a separate policy? Could it have something to do with the quality, size, service and expertise of the standalone carrier that administers the policy?

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