No doubt about it: Employers are likely confused about how to approach dental benefits in the wake of the ACA. And, they’ll probably look to you—their trusted broker—to explain dental that’s embedded in medical plans versus stand alone dental plans, coordinating dental coverage, duplication and so on. Here’s some info from the National Association of Dental Plans (NADP) that should help you make sense of it.

Embedded Dental or Stand Alone?

Today, 99 percent of dental benefits are sold under a separate policy from medical coverage. In fact almost 44 million consumers working for employers of 100 or fewer have separate dental coverage. About 1 percent of consumers have dental benefits as part of their medical policies.

In exchanges, consumers will continue to have these options, i.e. children’s dental benefits within their medical policies or a medical policy plus a separate dental policy covering their children. In most state exchanges, consumers will also have the option of adding dental coverage for themselves and their spouses. In federally-facilitated exchanges, consumers will have the options of adding dental coverage for themselves and dependents that do not qualify for pediatric dental services.

In the small group and individual market outside of exchanges, the ACA makes a change in the way coverage is currently offered. It requires ALL medical policies offered to consumers to include children’s dental coverage. Thus, the separate dental policies that now cover 22.9 million children in the small group and individual market will be duplicated at least in part by medical coverage, beginning in 2014.

To avoid duplication in premium costs in 2014, consumers with separate dental policies will have to decide whether to continue them or drop their children from the dental policy. One key issue in making this decision is whether the dentist their children now see is in the network of the medical carrier. Another is the scope of benefits set by the state for children’s dental services that is covered under the medical plan, as some states will offer limited dental benefits for children.

Stand Alone: Something to Keep in Mind

A 2011 NADP study showed that employees ask for dental benefits—and ask for them often. As a broker, there’s no better time to offer dental benefits by selling stand alone plans to employers. Brokers are facing uncertainty when it comes to commissions, with medical plans embedding dental. However, the ancillary benefits market—which includes dental—will be a steady source of revenue for brokers. Since it’s in demand, this is great news.

About NADP
National Association of Dental Plans (NADP), a Texas nonprofit corporation with headquarters in Dallas, Texas, is the "representative and recognized resource of the dental benefits industry." NADP is the only national trade organization that includes the full spectrum of dental benefits companies operating in the United States. NADP member plans provide Dental HMO, Dental PPO, Dental Indemnity and Discount Dental products to 160 million Americans, more than 90 percent of all Americans with dental benefits. Follow NADPorg on Twitter.