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02/18/2013

CDA fights for patient options in health care reform


The state of California continues to prepare for the full implementation of the federal Affordable Care Act (ACA) and CDA is working to ensure that dental patients are not limited to coverage offered by medical plans. CDA is pushing for patients to have a flexible range of coverage options and the ability to choose their dentist, a model that reflects the way dental care historically has been provided.

The ACA’s mandates on individuals to obtain health insurance are scheduled to take effect Jan. 1, 2014.

The central place where these issues are being addressed continues to be California’s Health Benefits Exchange, recently re-named Covered California. State health benefit Exchanges are the marketplace called for by the ACA where uninsured individuals and small businesses can shop for medical and dental benefits. Overseen by a five-member board of directors, the state Exchange will be contracting with individual health, dental, and vision plans (and combinations thereof) to offer the essential health benefits called for in the ACA (which must include pediatric dental benefits).

“CDA has for many months been working closely with Covered California Board members and staff to help them understand the dental benefits market and how it differs from the medical model,” said Robert Hanlon, DMD, chair of CDA’s Government Affairs Council. “On the surface, the Exchange is charged only with offering pediatric dental benefits to a particular subset of the market. However, because its products must also be offered outside of the Exchange, and because they have agreed to offer adult dental benefits as well, the Exchange’s decisions in the months ahead may be very significant for patients and dentists.”

The issues to be dealt with in the coming months could be legislative as well as regulatory. The most important issue the Exchange is grappling with is the respective role of different dental benefit models. Although both the federal law and the state Exchange have made clear that standalone dental plans can be made available to enrollees, full-service health plans may not have the flexibility to offer products that do not include pediatric dental. This would mean that a parent wishing to enroll their child in a standalone dental plan would have to pay duplicate premiums. It also is not clear that health plans can offer childless adults health insurance products that do not include pediatric dental benefits, which by definition they do not need. These questions may need to be resolved legislatively later this year.

“More than anything, CDA is arguing that families need the ability to select coverage that includes the dentist of their choice,” said Hanlon. “While full-service health plans may themselves decide to begin offering dental benefits, that should not preclude a family from choosing the type of plan that best meets their needs. We believe that failure to do so would result in major disruption of a dental insurance marketplace that works well for many patients already.”

CDA is also advocating the importance of making enrollees’ dental coverage options as transparent and easy to understand as possible at the time of purchase. CDA argues that dental benefits offered by health plans should be separately priced and offered, so that enrollees (whether they are new to dental coverage or not) can easily make comparisons with other dental benefit options. The Exchange’s online purchasing system must be able to clearly show families all their dental benefit options, including exactly what each will cost and which dentists are available.    

As these issues are clarified, CDA will provide information and resources to its members to help them prepare and work with their impacted patients.

“These issues are complex, and CDA is in daily communication with Exchange officials, key legislative staff and regulatory entities,” said Hanlon. “As information becomes available, we will keep members apprised.”

For more information, please contact Nicette Short at CDA at nicette.short@cda.org or 916.554.4970.