5 Things Parents Must Know About the ACA and Pediatric Dentistry

5 Things Parents Must Know About the ACA and Pediatric Dentistry


The ACA or the Affordable Care Act has 10 categories of EHB (Essential Health Benefits). Pediatric dental care is one of these categories, combined together with vision care. According to the Act, certain services must be included in your health insurance plan and the insurance company cannot charge you more for these services. This is good news for you and your child, in terms of dental care and also for pediatric vision services. It’s not like you need any further motivation to focus on your child’s dental care but this is news that could make it a bit more affordable for you. 

1. Pediatric Dental Care is Not Going to be Free for Kids Because of the Words “No Additional Cost”

Don’t get confused by the terminology used in the Act because as far as pediatric dentistry and vision services go, the Act is not quite clear. While mental health services, maternity services and other services are quite clear in their defined scope, dental care is not clearly laid out. Additional cost sharing might not be present but that doesn’t mean that, as a parent, you would incur no cost at all. For instance, when you get your child’s teeth examined or pay for preventive services, the cost sharing aspect disappears. However, the cost is still a very real element in these instances. This is why, instead of guessing, you should consult your health insurance provider about a list of things that would be included.

2. Not Every Thing Is Covered and It Varies From State to State

The benefits are not uniform across all states and so, as a parent, your job is to find out what is included in your benefits and what is excluded. For example, when orthodontia is concerned, every little requirement of your child might not be covered. The necessary treatment is obviously included but cosmetic treatments would involve some amount of cost sharing. If your child’s needs require it, you should consider increasing your insurance coverage. Preventive treatment and check-ups such as x-rays, scans, etc. are included but beyond that, contact your insurance provider. 

3. The Benefit Can Be Obtained with a Health Plan or a Separate Standalone Plan

There are two ways in which you can get these benefits for your child – purchase it on a standalone basis or get it embedded in a health plan. When you go to get a health plan, pediatric dental care would not be included in it if the insurance provider has a reasonable expectation of you already having access to such a thing. For example, if you have a standalone plan for pediatric dental care, there is no need for the health plan provider to embed the same thing in your health plan. However, if the exchange of your state does not offer any such standalone plans, your health plan would pediatric dental care embedded in the plan. 

4. Age Cap of ACA’s Pediatric Dental Benefit is 19 Years 

One thing that distinguishes the Pediatric Dentistry section of the Affordable Care Act is that the age cap of 19 years is different and is not used in the industry or anywhere else in the Act itself. According to the American Dental Association, “pediatric dental care” usually ends around 12 years of age. Under Affordable Care Act, parent’s general coverage of health insurance continues till 26 years of age. If you notice the norms of state plans like CHIP and Medicaid, you will notice that the age cap for the same is 21 in majority of the states. 

5. Overall Benefits Due to ACA’s Focus on Pediatric Dentistry

Obviously, the benefits are for all to see. If your child’s teeth are healthy, overall health will react accordingly. On the other hand, problems with teeth and oral health can often cause illnesses and diseases in children. This is why, in a way, the ACA is rewarding you and your child for focusing on dental care. 

Getting a good dental plan is important for the whole family. Get a plan that not only ensures top facilities for your child’s dental health but also works out for you. Remember, great dental health starts at an early age with knowledge, proper awareness and a great pediatric dentist.


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