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Affordable Care Act and Dental Coverage


A very controversial subject these days is the Affordable Care Act (ACA), a comprehensive health reform act that was signed into law by President Obama in March, 2010.  The goal of ACA is to make preventative health care more affordable and accessible for all Americans.  ACA enrollment will begin on October 1, 2013, for coverage that begins on January 1, 2014.  All Americans will be required to purchase health coverage or will be accessed a fine by the federal government.

Several aspects of the ACA pertain to dental care.  Children under the age of nineteen years of age will receive dental care under  essential health benefits (EHB).  The PEW Center on the States has estimated that approximately 5.3 million children are expected to gain some type of dental benefits through the ACA by 2018, a five percent increase from 2010.

Dental coverage for children will vary as each state sets its own package of EHB, within the Department of Health and Human Services (HHS) guidance. Those states that have finalized their EHB packages are using state CHIP (Children’s Health Insurance Program) programs to define children’s dental services. Each state will determine what is “medically necessary” in its dental coverage for children.

Dental benefits for adults are not part of the EHB.  However, approximately 17.7 million adults are expected to gain dental coverage as a result of this act with the majority being covered under Medicaid.  This coverage will vary state by state as each state has its own dental benefits policy under Medicaid.  The ADA (American Dental Association) estimates that about 4.5 million adults are expected to gain extensive dental benefits through Medicaid, and that about 800,000 will gain private dental benefits through health insurance exchanges (HIX).  When all of these increases are combined, approximately five percent more adults will have dental coverage than in 2010.

According to the results of a study  the ADA commissioned by Milliman, Inc., the ACA is estimated to increase dental spending in this country by an estimated $4 billion, with the largest effect being seen in the Medicaid population.  The study found that  ACA is expected to add $1.6 billion in expenditures by adults and children gaining private dental benefits through HIXs and ESI(Employer-sponsored Insurance), and generate an additional 10.4 million dental visits per year through Medicaid by 2018.

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Dr. Mark Gasbara
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    Mark J. Gasbara D.D.S.

    1215 Annapolis Road, Suite 208, Odenton, MD 21113
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