New report shows consumers have more pediatric options through health insurance marketplaces

May 5, 2015

Consumers searching for medical plans with embedded pediatric and/or family dental benefits have more options than ever on the health insurance marketplaces, according to a new study by the ADA Health Policy Institute.

Consumers searching for medical plans with embedded pediatric and/or family dental benefits have more options than ever on the health insurance marketplaces, according to a new study by the ADA Health Policy Institute.

In the 40 states examined for this study, 35.7 percent of medical plans have embedded pediatric or family dental benefits. This is a significant increase over 2014, when 26.8 percent of plans offered such benefits, according to the study, authored by Cassandra Yarbrough, M.P.P.; Marko Vujicic, Ph.D.; and Kamyar Nasseh, Ph.D.

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Other findings include:

  • While pediatric dental benefits are an essential health benefit under the Affordable Care Act, many plans do not offer first-dollar coverage for preventive dental services. Medical plans with embedded dental benefits are more likely to offer first-dollar coverage than stand-alone plans.

  • Pediatric dental benefits purchased through medical plans are, on average, less costly than purchasing standalone plans.

  • Healthcare.gov, the government's website for federally facilitated marketplaces, is more transparent about dental benefits coverage and cost-sharing than it was in 2014.

  Pediatric dental benefits are one of the 10 essential health benefits all small-group and individual-market health plans must cover. However, health plans sold through marketplaces are not required to include pediatric dental benefits as long as there are standalone plants available for purchase.  

To learn more about the study and its findings, read the research brief by clicking here.

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