Your Dental Practice and the Affordable Care Act

Posted by Alissa Gavrilescu on Apr 24, 2014 9:57:23 AM



Medical coverage, state and federal exchanges have by and large received the majority of the press and attention of legislators. However that doesn’t mean that dental isn’t an important component of the Affordable Care Act (ACA). There are 10 Essential Health Benefits (also known as EHBs)–pediatric dental coverage is one of those required EHBs. As a dentist, there are some things you’ll need to know.

Will the ACA impact your dental practice?

Those of us in the insurance industry, whether on the carrier, employer, broker or provider side, will experience some changes in the way we operate as a result of health reform. Ultimately, the health care delivery system as a whole is shifting.

You and your staff should be well-versed on the benefit coverage for the dental EHB and plan levels available. Your customers will undoubtedly have questions.

You’ll also be seeing an influx of new patients, which is certainly not a bad thing as a practice owner. By 2018, more than 3 million children are estimated to obtain dental coverage as a result of state and federal exchanges. And that 3 million doesn’t take into account the number of children who have private dental insurance – and that rate continues to grow as well.


How will this new dental EHB affect your patients?

Your patients will be impacted in a few ways. You might be seeing patients who haven’t had access to insurance before. They might not be as familiar with insurance, dental procedures or even oral health. Your office may need to spend a little more time with these patients to educate them on the procedures they need, the costs and the value of oral hygiene to their overall health.

Some of your patients might also have access to new or different insurance plans as a result of being moved to exchanges. Be prepared to help them navigate their new plans.

The dental EHB might be a different benefit structure than many of your clients are accustomed to using. Your office will have to consider how the dental EHB plans will work with private insurance plans the family may also have. Prepare for how your office will handle coordination of benefits with carriers to ensure timely claim payments for your office and quality of care for your patients.


Will the medical device tax impact my dental practice?

The medical device tax is not limited to medical. Dental devices are also subject to the tax, which is intended to help fund the ACA. The ADA covers the nuances of this tax quite well and is a must-read for any dental practice owner.


What dental plans can your office expect to see?

Each state has selected a dental EHB standard. Find out what coverage standard is required in the state you practice. Download our free dental EHB state map to find out which dental EHB standard is in your state. ACA-certified dental plans also have levels to rank the plan’s benefit richness; plans are listed as either low or high when consumers are shopping for benefits on the exchanges.


Remember, regulations are changing so it’s important to keep track of changes that might impact your practice or your patients. Here are some great websites to bookmark and check for updates on reform:


Dental EHB Map

Topics: ACA and dentistry, health reform and dentistry

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