Dental Coverage for Seniors Under Obama Care? – Not in California

Have you been wondering if you can get dental coverage under Obama Care?  Sorry, unless you’re a child — not  in California; at least not the first year.  Adult coverage may be added in 2015.  Older adults and their caregivers have complained for years that Medicare, which now covers 52 million Americans, does not provide dental benefits.

For some adults in other states with Medicare, the online insurance exchanges created by the Affordable Care Act may offer an alternative. The vast majority should not purchase health insurance on the exchanges.  But unless you are enrolled in a private Medicare Advantage managed care plan that already includes dental benefits, Medicare beneficiaries are legally permitted to purchase dental plans on the exchanges.

“There is nothing in the Affordable Care Act that prohibits the sale to Medicare beneficiaries of stand-alone dental plans on the exchanges,” said Leslie Fried, policy and programs director at the National Council on Aging in Washington, D.C.

Still, there are drawbacks. The standalone dental plans for adults can set annual dollar limits on coverage and don’t have to comply with caps on out-of-pocket spending mandated by the A.C.A. for health plans. Insurance premium subsidies and assistance with out-of-pocket expenses are not available. And in some states, exchange dental plans can reject adult applicants because of pre-existing conditions.

The choices vary dramatically by state.

In the 36 states where the federal government is running exchanges, dental coverage is available only to those who also buy health coverage, said an official at the Centers for Medicare and Medicaid Services, the agency operating those exchanges. That means someone with Medicare cannot purchase stand-alone dental coverage, even though federal law allows the sale of these policies to Medicare beneficiaries.

The Maryland Health Connection offers 20 dental-only policies that seniors who have Medicare can buy, said Danielle Davis, communications director for the Maryland Health Benefit Exchange.

Covered California, California state’s insurance exchange, offers stand-alone dental plans that cover only children.  Adult coverage may be added next year.

New York officials announced in August that the state’s exchange would sell 10 dental plans, but now say the policies are wrapped into health plans and are not offered à la carte.

In the District of Columbia, seniors in Medicare can choose from five stand-alone dental plans in DCHealthLink, but all also include coverage for children.

These plans cannot turn away applicants because of pre-existing conditions, but dental plans sold outside the exchange can, said assistant insurance commissioner Philip Barlow. That’s not true everywhere, however.

So what’s the bottom line?

Medicare beneficiaries may be able buy standalone dental plans on certain state exchanges; however, they may not be much better than those available outside the exchanges.  Many standalone exchange dental plans include coverage for children, which seniors don’t need, and that can increase the premiums.

If you have any questions about “The Affordable Care Act” (Obama Care), give us a call at 599.924.1225, and we will help you figure out your best choices.

The information in the blog was taken from:  The New York Times, Thursday, November 7, 2013, “Dental Coverage on the Insurance Exchanges,” by Susan Jaffe

“It’s a huge problem,” said Barbi Jo Stim, a geriatric care manager at Jewish Family and Children’s Services of the East Bay, a social service agency in Berkeley, Calif. “If older adults can’t afford the dental work they need, they can’t chew, they don’t get the nutrition they need and that can affect their overall health.”
Dental assistant Albert Hernandez helped X-ray the teeth of a nursing home resident in San Antonio, Tex.Jennifer Whitney for The New York Times Dental assistant Albert Hernandez helped X-ray the teeth of a nursing home resident in San Antonio, Tex.

For some adults with Medicare, the online insurance exchanges created by the Affordable Care Act may offer an alternative (assuming they become functional in the near future). True, the vast majority should not purchase health insurance on the exchanges. But unless they are enrolled in a private Medicare Advantage managed care plan that already includes dental benefits, Medicare beneficiaries are legally permitted to purchase dental plans on the exchanges.

“There is nothing in the Affordable Care Act that prohibits the sale to Medicare beneficiaries of standalone dental plans on the exchanges,” said Leslie Fried, policy and programs director at the National Council on Aging in Washington, D.C.

Still, there are drawbacks. The standalone dental plans for adults can set annual dollar limits on coverage and don’t have to comply with caps on out-of-pocket spending mandated by the A.C.A. for health plans. Insurance premium subsidies and assistance with out-of-pocket expenses are not available. And in some states, exchange dental plans can reject adult applicants because of pre-existing conditions.

The choices vary dramatically by state.

In the 36 states where the federal government is running exchanges, dental coverage is available only to those who also buy health coverage, said an official at the Centers for Medicare and Medicaid Services, the agency operating those exchanges. That means someone with Medicare cannot purchase standalone dental coverage, even though federal law allows the sale of these policies to Medicare beneficiaries.

The Maryland Health Connection offers 20 dental-only policies that seniors who have Medicare can buy, said Danielle Davis, communications director for the Maryland Health Benefit Exchange.

Covered California, California’s insurance exchange, offers stand-alone dental plans that cover only children.  Adult coverage may be added next year.

New York officials announced in August that the state’s exchange would sell 10 dental plans, but now say the policies are wrapped into health plans and are not offered à la carte.

“The need for separate adult dental policies was not raised during public forums about New York’s exchange benefits package,” said Lisa Sbrana, counsel to the N.Y. State of Health exchange. “We would definitely consider it if New Yorkers expressed an interest in it.”

In the District of Columbia, seniors in Medicare can choose from five stand-alone dental plans in DCHealthLink, said Mila Kofman, executive director of the District of Columbia Health Exchange Authority, “but all also include coverage for children.”

These plans cannot turn away applicants because of pre-existing conditions, but dental plans sold outside the exchange can, said assistant insurance commissioner Philip Barlow. That’s not true everywhere, however.

So what’s the bottom line?

Medicare beneficiaries may be able buy standalone dental plans on certain state exchanges; however, they may not be much better than those available outside the exchanges.  Many stand-alone exchange dental plans include coverage for children, which seniors don’t need, and that can increase the premiums.

Give us a call at Bressler & Company (559.924.1225) if you have any questions about “The Affordable Care Act” (Obama Care).

Information in this blog was taken from “The New York Times, Thursday, November 7, 2013, “Dental Coverage on the Insurance Exchanges”, by Susan Jaffe  (http://newoldage.blogs.nytimes.com/2013/11/01/dental-coverage-on-the-insurance-exchanges/?_r=0#!)