Issue Briefs

Most current issue briefs

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Dental Benefits Choices for Children: One Size Does Not Fit All

Families consider many factors in selecting a plan for dental services—like whether they can continue to see their dentist. But out-of-pocket cost is the main concern. This infographic shows the total yearly out-of-pocket costs for one child with different dental service needs under two typical medical plans and two typical separate dental plans. (May 2015)

  

 

Plan Selections on Exchanges in 2015 

Click the image to find a breakdown of health and dental plan selections on insurance Marketplaces in 2015. (3/10/2015)

 

 

Chart of Dental Plan Selections on Exchanges in 2014

Click the image to find a chart detailing the selection of Qualified Dental Plans on insurance Marketplaces in 2014. (9/4/2014)

 

 

Consumer Tips on Shopping for Dental in Marketplaces

Pediatric dental coverage is part of the essential benefits offered on insurance Marketplaces. In most Marketplaces, consumers can choose pediatric dental coverage as part of their medical policy or as a separate policy. Here are 4 tips to help make your choice a wise one. (11/7/2013)

 

 

Offering Dental Benefits in Health Exchanges, A Road map for Federal and State Policy Makers

As state policymakers work towards implementing Exchanges, the National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA) have provided options, recommendations, and background for best practices on how to include dental policies into health Exchanges. (11/1/2011)

Impact of Missing Premium Assistance for Pediatric Dental Benefits in 2015

The Affordable Care Act (ACA) requires tax credits to be available for lower income individuals purchasing health coverage on health insurance Marketplaces. Due to IRS regulation implementing ACA, the calculation of tax credits does not take into account the value of pediatric dental benefits. This map is a summary of NADP analysis of Marketplace offerings and the impact of missing premium assistance for dental. (3/11/2016)

  

 

Map of Dental Plan Selections on Exchanges in 2014

Click the image to find maps illustrating the selection of Qualified Dental Plans on insurance Marketplaces in 2014. (9/4/2014)

 

   

The Basics of Dental Coverage and the ACA

The Affordable Care Act (ACA) requires Americans to purchase health coverage in 2014 and thereafter or pay a fine. Health coverage is defined as medical coverage offered through employers or public programs as well as individual policies. For the small group and individual market and Exchanges, the ACA sets a specific group of benefits, i.e. Essential Health Benefits (EHB) as the minimum health coverage that can be offered in those markets. Part of this set of benefits is “pediatric services, including oral and vision care.” (7/1/2013)

 

State Selection of Dental EHB Benchmarks

The ACA defines Essential Health Benefits (EHB) to include pediatric dental services, and states determine the scope of services covered with their EHB package. This map reviews the state-designated benchmarks for pediatric dental benefits. (4/1/2014)

 

  

Certification of Dental Plans Offering Pediatric Dental Through an Exchange

NADP and the Delta Dental Plans Association (DDPA) review the QHP certification requirements and provide guidance to state and federal Exchange officials in applying the requirements to separate dental policies and dental plans. (5/1/2012)

State Interpretations of Reasonable Assurance

U.S. Department of Health and Human Services (HHS) regulation implementing the ACA utilizes new terminology, including "reasonably assured," to describe health carrier obligations in the small group and individual market. This Issue Brief outlines state guidance on reasonable assurance. (May 2015)

 

  

 

Regulatory Treatment of Pediatric Dental Coverage outside Exchanges

The ACA includes coverage for pediatric oral health services in the small group and individual market as part of the Essential Health Benefit (EHB) package. This infographic outlines the regulatory treatment of dental benefits in these markets along with 2014 market data and a map of related state regulation. (May 2015)

 

 

Dental Benefits and Consumer Tax Credits within the ACA

The Affordable Care Act (ACA) requires tax credits to be available for lower income individuals purchasing health coverage on health insurance Marketplaces. Due to IRS regulation implementing ACA, the calculation of tax credits does not take into account the value of pediatric dental benefits.

 

 

EHB Dental Benchmarks: Premiums and Actuarial Value

This Issue Brief includes a brief summary of how pediatric dental is included within current HHS EHB guidance, the costs and actuarial value levels of those dental benchmarks, and recommendations from the dental benefits industry. (6/1/2012)

 

 

Equitable Consumer Access to Dental Coverage Inside AND Outside the Exchange

The ACA allows for separate dental policies to provide coverage for pediatric dental services and meet the Essential Health Benefit requirement inside the Exchange, but does not explicitly allow this outside Exchanges. As a result, dental policies in place today as separate dental plans outside the Exchange in the small group and individual market will be duplicative to what a medical plan must offer. (5/1/2012)