teeth

ACA and Dental Insurance: 5 Things to Think About

While much of the attention on the implementation of the Affordable Care Act has focused on medical coverage, Arizona residents are also able to purchase dental insurance through the Federally Facilitated Marketplace (FFM) beginning on Oct. 1, 2013, through March 31, 2014.

Delta Dental of Arizona states, “We are especially pleased that the new law recognizes the special value of stand – alone dental plans. Under the terms of the law, those who seek coverage through the Federal insurance exchange will be able to purchase separate coverage from dental carriers, like Delta Dental, that have a track record of providing services in the most cost-effective, consumer-friendly manner.”

The Federally Facilitated Marketplace can be found at www.Healthcare.gov and is particularly important for Arizona residents who do not have access to coverage either through their employers, on their own, or who aren’t covered by Medicaid. The new health care law requires that most U.S. citizens and legal residents have health insurance or pay a penalty. People are not required to purchase health and dental insurance through the exchange; they can go directly to a benefits carrier. However, if they might qualify for federal tax subsidy to lower their premiums the FFM is the place to go. Members can begin enrolling as of October 1 with coverage beginning Jan. 1, 2014.
Delta Dental of Arizona offers the following information to help you understand how the Affordable Care Act has changed dental benefits and to select a dental plan that best fits your needs.
1. Not All Networks on the Exchange are Created Equal
Dental benefits are provided through an arrangement with local dentists. Dental carriers enter into contract with the dentist, who in turn agrees to charge a certain price. The key to a great network is how your plan contracts with dentists to get you the lowest cost and highest quality of care. Delta Dental of Arizona negotiates a low cost with our statewide network of more than 3,100 dentists, and we protect members from balance-billing (the difference between what the plan pays and what the dentist charges). Lower out-of-pocket costs mean that the annual dental benefits stretch further.

But not all networks are created equal. Some dental carriers offer a small discount from the standard dental office fee. This practice can shift the burden of expense to the patient for costly services such as root canals and crowns. And the discounts offered may apply to only a very narrow network of dentists. This means the range will be smaller than a larger, robust network. Make sure dental insurance offers the lowest cost…with the most choice.

2. Do the Math
Be sure to understand what payments you are responsible for. In addition to the monthly premiums, there may be cost-sharing arrangements on services. Look for a plan that encourages preventive care by covering 100% of the costs of exams, cleanings, x-rays, sealants and fluoride treatments. Secondly, look at deductibles – the amount that must paid before the insurance company pays for all or a portion of the costs. Deductibles vary across plans. Lower monthly payment plans will typically have a higher deductible. In addition, there are also out-of-pocket maximums, which mean that once the out-of-pocket maximum has been paid, the insurance plan pays 100%.

Keep in mind; if you are purchasing your dental benefits through a medical insurance carrier on the new online insurance marketplace, you need to look carefully at how deductibles and out-of-pocket maximums apply. For example, a deductible for a health plan might be $2,000 compared to a typical deductible for a stand-alone dental plan that ranges from $25 to $100. This means you could pay for a lot of dental costs before the medical plan starts paying 100%. That can be costly for the average family.

3. An Ounce of Prevention
When choosing a dental plan, it is important to review what services the plan covers. While it may seem like all plans are the same, many vary in coverage. Look for an insurance plan that emphasizes preventive and diagnostic care. Many people don’t realize that costly and painful dental problems can be prevented by regular visits to the dentist…even at the earliest of ages. The American Dental Association recommends that children see a dentist by age 1. Dental problems such as cavities are nearly 100% preventable.

4. Getting the Most Value
Every family has a unique situation. It is important to assess dental plans based on your family’s needs. Do you have children who are ready for braces? Might you be heading for a crown or root canal? Are implants or dentures in your future? Or are annual exams, cleanings and X-rays the extent of your dental needs? Make sure you are paying for services you need and getting the best value on those services. It’s not just about cost; it’s about coverage as well. Look for the coverage that works best for you and your family.

5. Who Are You Doing Business With?
You are sure to come across many companies in the online marketplace. Some are big, but many will be small, new businesses. It is important to make sure you’re working with an established company. Review their company profile and make your decision based on the answers to several questions. How long have they been in business? How many years have they been specializing in dental insurance? Are they local or national? There has been a lot of consolidation in the insurance industry. How much experience your dental insurance company has processing and paying dental claims is important. You don’t want to get a notice from another company you are not familiar with that has subcontracted with your insurance company because that means dental insurance is not your insurance company’s main area of expertise. Established dental carriers have the benefit of smooth, accurate operating procedures.

Delta Dental of Arizona is a Qualified Health Plan issuer in the Federally Facilitated Marketplace. For questions about buying insurance on the Arizona Health Insurance Marketplace, visit www.HealthCare.gov in English or www.CuidadoDeSalud.gov for Spanish, or call (800) 318-2596. For questions about Delta Dental of Arizona plans, visit www.DeltaDentalCoversMe.com, call toll-free at:  800-352-6132, Monday through Friday (CT) or via email at customerservice@deltadentalaz.com.