Dental Plan Costs Range Widely on New Exchanges

Laird Harrison

October 17, 2013

Dental plans began selling on the new Affordable Care Act (ACA) health insurance exchanges this month, with huge ranges in prices from 1 state to the next.

Monthly premiums for stand-alone dental plans on the federally run exchanges ranged from $6 per child for the lowest-cost plan in Utah to $65.75 for the highest-cost plan in South Carolina, according to data released by the US Department of Health and Human Services to dental interest groups.

"It's a much larger gap than I would have expected," Colin Reusch, senior policy analyst for Children's Dental Health Project, told Medscape Medical News.

Reusch, whose organization has lobbied for regulations favoring low-cost plans and generous benefits, said he could not account for the big range in costs.

Evelyn Ireland, executive director of the National Association of Dental Plans, gave Medscape Medical News this explanation in an email: "State differences in premium reflect cost of services and utilization patterns in the state."

The ACA includes pediatric dental care as one of the "essential benefits" that must be offered through the new exchanges, but unlike the other essential benefits, they are not mandatory under federal regulations: Uninsured individuals can choose whether to buy stand-alone plans along with separate health plans, health plans that include dental benefits, or just health plans and no dental benefits.

The states of Washington and Nevada have made pediatric dental benefits mandatory under state regulations, and other states are considering whether to follow suit.

On average, stand-alone dental plans are charging $34.17 per child per month, the data show. The average monthly premium per child for a low plan in West Virginia was $14.61; in Wyoming it was $43.89.

The average put the cost of the new plans above that of a "typical small employer dental preferred provider organization" plan available last year, which was about $21 per child per month without orthodontia coverage, the National Association of Dental Plans estimated. However, the ACA requires a minimum level of services that exceeds the services in many of these traditional plans.

"Low" plans cover 70% of the charges for each procedure, whereas "high" plans cover $85%.

Many dental plans previously offered to individuals set a cap on the amount the plans will pay out; for example, they might allow only $1000 or $1500 in benefits per year. The ACA prohibits such caps.

"It makes dental insurance look more like true insurance," Reusch said.

The number of dental plans available to individuals and small groups shopping on the exchanges also ranges widely among states and even differs between counties within a state.

Texans had an average of 49.165 dental plans offered by 11 different insurance companies, whereas Alaskans had only a single plan available for the whole state.

"I thought at first the states with less competition would have more expensive plans, but I didn't find much correlation," Reusch said. He also looked at the incomes of residents for different states but did not find a correlation with prices of dental plans there, either. The numbers from one state to the next could come closer over time, he said. "I would love to see competition factor in bringing prices down into some equilibrium."

It is not clear yet what prices will look like when plans become available through the exchanges for small businesses. Separate portals for employers have not yet opened. Data are also not available on those states that are operating their own exchanges, only on those run by the federal government. In addition, information on dental benefits embedded in medical plans has been hard to obtain: One company valued the cost of dental benefits in a health plan at less than $5 a month for a plan offered in Connecticut, Reusch said.

"The ACA has made health plans a major competitor in the dental plan market," he noted.

However, Reusch also acknowledged that the embedded benefits could not be compared "apples to apples" to stand-alone plans because of differences in the way benefits are provided.

In addition, Ireland cautioned that dental benefits embedded in the Connecticut health plans had high deductibles. "In that state, the medical plans that embedded pediatric dental in bronze plans made pediatric dental subject to the full deductible of the plan — some were $2000, some $3500 for a family, etc," she said in an email. "This would mean that pediatric dental costs will be borne fully out of pocket by consumers until this deductible is reached. This is something worth warning consumers to look for when coverage is embedded."

Consumers trying to buy dental benefits on the federally run exchanges have encountered some of the same technical glitches besetting those buying health plans, Ireland said.

After a slow start, however, the applications are "starting to flow on a regular basis," she said. "The issues that have been raised are not uncommon to any large launch and are being handled relatively quickly and professionally, especially given the myriad of issues that they are addressing in the consumer account set-up and shopping experience."

Delta Dental Plans Association confirmed it has been affected by the technical bottlenecks. "Enrollments are slow to come in, though we are not discouraged, given the system limitations that have presented themselves in the first few weeks," the organization said in a written statement.

The association pointed out that plans meeting the standards of the ACA may also be available directly from the insurance companies.

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