A rumor was brought to our attention recently about the dental component of Essential Health Benefits (EHBs): in 2016, the dental component of the EHBs mandated by the Affordable Care Act (ACA) would evolve from pediatric only to full dental coverage.

True or false?

After researching, we’ve determined that this rumor is false. However, we found language relevant to dental in the proposed rules for 2016, whereby a request has been made to amend the regulation to specify that pediatric dental coverage should continue until the end of the plan year in which the enrollee turns 19. This would specify when the coverage would cease in the year the child turns 19; states, issuers and stakeholders want clarification on what “at least age 19” means in the current language. 

At this time, this is still a proposed rule. The document of proposed rule changes is almost 200 pages long, so it may take some time to find out the outcome of whether the proposed language was approved. We will certainly keep our dental insurance brokers informed about all things ACA once we know.

In the meantime, as a refresher, here are the official 10 EHB categories:

1) Ambulatory patient services

2) Emergency services

3) Hospitalization

4) Maternity and newborn care

5) Mental health and substance use disorder services, including behavioral health treatment

6) Prescription drugs

7) Rehabilitative and habilitative services and devices

8) Laboratory services

9) Preventive and wellness services and chronic disease management

10) Pediatric services, including oral and vision care