Pediatric Dental

[TxOnline]

The govt speaks with forked-tongue.
On-exchange: No pediatric dental required
Off-exchange: Carriers are being forced to include pediatric dental
Some embed the pediatric dental.
Others add-it-on at the end (so their medical prices look better than next co).
Some let you attest to the fact that you already own dental for your children.
Others leave it off entirely (and don't require attestation).
You've just gotta memorize each carrier's dental requirements.

If I forget to tell client that we'll be forced to add-on dental at end of CERTAIN carrier apps; it sometimes comes back to bite me. They wanna start all over & pick the cheapest plan again.
If I show dental up-front (included in total premiums), some of them tell me they saw it cheaper on govt site. And, they DID!

I wish HealthSherpa worked for SEP's. Then, I could avoid this add-on-dental confusion entirely. And, give them a FAST, cheapest-price solution.
I'm mostly writing SEP's right now...because of the thousands who are losing their non-GF policies on Jan 1st.

 

[yorkriver1]

Then, if I understand this correctly, the pediatric dental for those who bought it or it's embedded in their plan, most of them I've seen don't pay until the deductible is met. Show me a low deductible on most off Marketplace plans.

 

[AllenChicago]

If you don't have a stand alone dental plan they will add the cheapest one to the plan. I don't think they charge more for it, its kinda baked into the rates. That's BCTX.

Yes all plans have to have it even if no one can use it.

I didn't recall seeing any warnings and/or notices from the carriers this past O.E. regarding Pediatric Dental. Has the mandate that Pediatric Dental be included with the Individual Health Insurance (either baked in, or stand-alone) been done away with?

 

[RayNY]

I didn't recall seeing any warnings and/or notices from the carriers this past O.E. regarding Pediatric Dental. Has the mandate that Pediatric Dental be included with the Individual Health Insurance (either baked in, or stand-alone) been done away with?

No, it has not been done away with. Carriers do their part: It's either baked in, or there's a yes/no question on the app asking if they have it. If yes, nothing happens, on the client to actually have it. If no, they're referred to a PED product (either internal or 3rd party).

No reason to talk about it, problem solved and nothing has changed.

 

[AllenChicago]

No, it has not been done away with. Carriers do their part: It's either baked in, or there's a yes/no question on the app asking if they have it. If yes, nothing happens, on the client to actually have it. If no, they're referred to a PED product (either internal or 3rd party).

No reason to talk about it, problem solved and nothing has changed.

I did all of my 2016 enrollments via HealthSherpa or ACAExpress. Neither had a dental purchase option. That explains why I thought the Pediatric Dental requirement was ditched. Our two viable carriers do/did not have imbedded dental.

Oh well..the insureds received the necessary documents stating that they have Minimum Essential Coverage, so I won't worry about it. Thanks for the reply, Ray!
-Allen

 

[RayNY]

I wouldn't worry. AFAIK, there's no way to check even though it technically makes the policyholder non-compliant and due a penalty.

1095's report the health coverage to the IRS, no dental info is ever sent.

It's on the carrier to verify, but if the person says they have it (app or follow-up), job done, even if they answer in error.

 

[yorkriver1]

We have two main carriers in the area. One has Pediatric Dental embedded in all plans on and off marketplace. The other does also, but one pays preventive before the deductible, the other doesn't.

Not heard of anyone getting tax penalty for no Pediatric Dental.

 

[AllenChicago]

July 11, 2016

The Internal Revenue Service issued some adjustments to the Premium Tax Credit (PTC) last week. The most notable change seems to be that the subsidy calculation will include the cost for Pediatric Dental coverage, where applicable.

News Article: Cost of kids' dental plans could be part of ACA subsidies

Details: IRS Proposed Rules Address Premium Tax Credits, Benchmark Premiums, And Pediatric Dental Plans

Something to look forward to when 2019 Open Enrollment comes around. I'm sure ObamaCare will stronger, and better than ever by then!
-ac

 

[yorkriver1]

I am getting this now, and it's helping to read the thread. My current client losing EHB from employer, choosing plans, including dental.

On Marketplace, a competitive medical plan has no pediatric dental, no harm, not required, but they do need dental. Off Marketplace, the competitive medical plan has pediatric embedded. Unless they state a need for immediate fillings/crowns, we won't put the kids on a separate dental plan.

Individual dental, wide network, BCBS, their portal says all their dental plans include embedded pediatric dental. Service reps say one of the plan types doesn't. I guess I will drop my campaign to get a straight answer, and go with the practical. The "adult" plan actually has better copay % on fillings than the stand alone pediatric coverage we could use for the 2 kids. 20% on general plan, 40% copay on pediatric plan. Both have an annual $50 deductible before any benefits paid, including preventive. $5 more in total per month if whole family is on one plan. Probably not worth the hassle of bringing it up unless they balk at pricing.

I do wonder about the folks who don't get stand alone dental including pediatric and have an off Marketplace medical plan without pediatric dental baked in. I have some higher income clients who would not appreciate a penalty.

 

[AllenChicago]

I am getting this now, and it's helping to read the thread.

I do wonder about the folks who don't get stand alone dental including pediatric and have an off Marketplace medical plan without pediatric dental baked in. I have some higher income clients who would not appreciate a penalty.

YorkRiver1, have you found in the IRS tax forms where it asks about Pediatric Dental? I have some QHPlan families without any type of dental, and they've never mentioned being required to pay a penalty for not having it.