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Dental Coverage: The Affordable Care Act (ACA)

Group 8 Rochenel Pierre, Pamela Carter, Jossener Joseph

University of North Florida

NGR 6892

Dr Jane McCarthy

5/22/2022
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Dental Coverage: The Affordable Care Act (ACA)

R.3590: The Affordable Care Act (ACA): Affordable Care Act (ACA) is a well-known

healthcare reform initiated in March 2010. The act involved an unending list of essential health

benefits in 2010. ACA key provisions offer coverage to many uninsured Americans and execute

measures that lower healthcare-based costs, improve system effectiveness, and eliminate

practices that involve a rejection of coverage following pre-existing disorders.

Division A: Affordable Healthcare Choices: The ten essential health benefits in

relation to ACA involve outpatient care, inpatient care treatment, emergency room visits, mental

health, treatment drugs, service for the injury/infirmity/chronic disorder, lab tests, preventive and

pediatric services (counting dental care)

Standards guarantee access to affordable care: ACA initially didn't offer dental plans.

Although, in 2016, dental coverage was provided through the health insurance markets. As per

ACA's website, dental coverage is a significant health benefit for kids. Therefore, its updates

require kids have dental insurance coverage (Bennie, 2021). This is despite whether their parents

don’t have. For the grown-ups, dental plans must be made accessible through the marketplace,

but they do not have to buy one for themselves.

Protection and standards for qualified health for health benefits plan: Section 1311

of ACA allows for a stand-alone dental plan that usually provide pediatric dental advantages to

contribute to state health insurance exchanges. If a stand-alone dental plan is provided in

exchange, then other insurance plans with limited dental benefits still can contribute to the state

exchange. These dental plans are exempted from providing necessary benefits packages and
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cost-sharing protections. Dental-only plans are accessible since the state health insurance

exchanges were executed in 2014.

Although the ACA of 2010 did not provide dental plans, the revised ACA of 2016

included dental coverage through health insurance marketplaces. The act requires all children

under the age of 18 years to have dental insurance coverage, but adults are not required. An

individual or a family can apply for the dental plan as a stand-alone dental plan or a combined

dental plan with health insurance (HealthCare.gov. 2022).

Plans have adjustable prices based on a person’s income. After selecting the stand-alone

or the combined dental plan, one is required to select a high or low category dental plan package.

Under the high plan, one pays a higher monthly premium for dental insurance and enjoys low

copayments and deductibles. This plan is beneficial for people who need more oral health

treatments. Under the low plan, one pays lower monthly premiums for the dental insurance plan

and incurs higher premiums and copays during dental care visits (HealthCare.gov., 2022). This

plan is beneficial to people who only need basic oral health care, like annual examination or

cleaning. Most care plans cover 100% of preventive dental care, such as cleanings, x-rays, and

checkups, and 80% of basic treatment like fillings, and 50% of complex dental care procedures,

such as root canals. 

The marketplace is available to US citizens who do not enjoy employer-sponsored

insurance plans. This marketplace allows various private insurers to compete for customers by

offering a variety of dental care plans based on cost and a person’s needs. An individual can

compare and apply for a plan via the marketplace during the enrollment period, which is usually

between November and December. After applying, the coverage takes place the following year.
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The marketplace categorizes care plans into bronze, silver, gold, and platinum. Platinum is the

highest tier and covers about 90% of all health expenses. It is also the most expensive plan

(Khorsandi, 2022). Lower-income individuals and families enjoy extra savings through premium

tax credits and cost-sharing reductions. 

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References

Bennie. (2021). Is dental insurance included in the Affordable Care

Act? https://www.bennie.com/blog/is-dental-insurance-included-in-the-affordable-care-

act#

HealthCare.gov. (2022). Dental coverage in the Marketplace.

https://www.healthcare.gov/coverage/dental-coverage/

Khorsandi, J. (2022). Does the Affordable Care Act Cover Dental Care/Insurance?

https://www.byte.com/community/resources/article/affordable-care-act-dental-coverage/