01/24/2013

CDA pushes for transparent offerings of dental benefits in health care reform implementation

By Nicette Short, CDA legislative/regulatory policy analyst

California continues to move toward the Jan. 1, 2014, implementation of national health care reform, and CDA has been working closely with policymakers on issues important to dentistry.

The implementation is expected to include:

  • the offering of a pediatric dental benefit as part of the Essential Health Benefit package;
  • an option for adults to purchase dental benefits in the individual and small business exchanges; and
  • the inclusion of stand-alone dental plans in the exchanges.

State health benefit exchanges are the marketplace called for by the Affordable Care Act (ACA) where uninsured individuals and small businesses can shop for medical and dental benefits. CDA is urging the California Health Benefit Exchange, now known as “Covered California,” to develop a level playing field in this new insurance marketplace to safeguard that stand-alone dental plans can fairly compete with dental benefits that are going to be included in medical benefit packages.

CDA is working to ensure that Covered California protects the existing patient-dentist relationship, gives families clear information to make good choices, and ensures parents purchase dental coverage for their children when purchasing medical coverage in the Exchange, as intended with the passage of the Affordable Care Act.

To achieve this and ensure a stable system that provides continuity with the dental benefits obtained by the vast majority of Americans, CDA believes that Covered California must make policy decisions that support stand-alone dental benefit offerings, and these policies should be crafted to meet the principles of continuity of care, transparency and affordability.

Continuity of Care. It will be critical for Covered California to deliver on the president’s promise of the ACA: no one should have to change doctors as a result of health care reform.

  • Most health plans currently do not offer dental benefits, and therefore do not have relationships with dental networks. It is unclear how health plans will be able to develop those relationships and build these networks in the next few months.
  • Stand-alone dental plans already have robust dental networks.
  • Therefore, the best opportunity that families have in maintaining their relationship with their current dentist and maintain that continuity of care is if stand-alone dental plans can thrive within the Covered California structure and process.

Transparency.  Covered California must ensure that consumers are provided a transparent set of options when purchasing dental coverage for their families.

  • Dental benefits offered by a health plan must be separately priced, separately offered, and have clearly identified provider networks. This will make it simple for families to have an apples-to-apples comparison and choose the best plan for them.
  • This is also a benefit to Covered California itself, ensuring that it has the information necessary to effectively monitor this brand new endeavor for health plans, and ensure this remains a real benefit for families and not just a benefit on paper.

Affordability. Covered California must ensure that consumer health care dollars are spent prudently and that it creates a system that entices “young invincibles” to purchase coverage.  

  • This can be achieved by using the flexibility afforded to the state by the federal legislation to allow childless adults to purchase products that do not include pediatric dental benefits, while still requiring all children to have dental coverage.
  • Childless adults should be able to tailor a benefit package that maximizes the spending power of their health care dollars. The ability to decline the pediatric dental benefit will free up dollars they could use to purchase optional adult dental benefits for themselves.
  • Using this federal flexibility in a responsible and thoughtful way will ensure affordability for consumers while also ensuring that families with dependent children access the dental coverage they need.

The Covered California board’s decisions on these issues will have a tremendous impact on Californian’s oral and overall health. CDA will be working closely with the board members and staff, as well as other key stakeholders, to address these critical issues in the months ahead. 

Health Care Reform, and California’s implementation of the law, will continue to be a topic of significant interest, as many of the decisions the state makes have the potential to affect the dental benefits and delivery system.

CDA will be offering a lecture on these topics and much more at CDA Presents in Anaheim, on Thursday, April 11 at 3:30 p.m., Ballroom B, Anaheim Convention Center. The presentation will update participants on all the issues covered here, as well as highlight how health care reform will likely impact dentists as small business/employers and as individuals.