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Health Care Reform Explained

The New Health Care Law and Dental Coverage

The law doesn't require insurers to cover dental care for adults, but that could change

Q. Does the health care reform law require insurers to offer dental coverage?

A. No. The law doesn't require insurers to cover dental care for adults, but there's a good chance that could change when the state insurance exchanges begin operating in 2014. These exchanges will be online marketplaces where consumers can easily compare prices and coverage and find the policy that best fits their needs.

The law says that health insurance plans sold on an exchange have to cover an "essential health benefits" package similar to the typical employer-sponsored health care policy.

Nearly half of the employers offering health benefits to their employees this year provide some kind of dental coverage, including 87 percent of employers with 200 or more workers, according to a recent survey.

Although adult dental care is not among some examples of benefits the law says must be covered, consumer advocates say it appears that the U.S. Department of Health and Human Services could include it in the regulations that will detail what essential benefits must be provided.

The exchanges also will give insurers the option of selling separate policies that only cover dental care. But the American Dental Association notes in its analysis of the law that "there are no assurances that this dental coverage will be substantial."

The law treats children differently from adults when it comes to dental care. Health care plans sold in the exchanges must include dental coverage for children. The age limit will be set in the regulations.

Other provisions of the law provide funding to improve dental care and other services provided at community health centers across the country, which serve patients regardless of their insurance or ability to pay. There also is money to provide student loans for dental and other medical education to graduates who agree to work in medically underserved areas.

Susan Jaffe of Washington, D.C., covers health and aging issues and writes the Bulletin’s weekly column, Health Care Reform Explained: Your Questions Answered.

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