Obamacare and Dental Insurance

 

by Gentle Touch Dentistry:Dr. Steven Polevoy.

For months, our patients have been asking us what the new Affordable Care Act means for their dental insurance. Up until recently, all we could do is shrug our collective shoulders as there was no clear indication in the law what, if anything, it intended to do with dental insurance plans.

The only way to find out was to sign onto the website, and see what was available.

So to help out our confused patients, and to be able to give answers more intelligent than “I don’t know”, that’s exactly what we did.

This is what we found:

In New York State, you can do one of three things on its exchange.

1.You can buy a medical insurance plan.
2.You can buy a medical insurance plan and a stand-alone dental insurance plan.
3.You can buy a medical insurance plan with a pediatric dental component.

We didn’t examine the medical plan options. Please feel free to contact your medical doctors for this information. We don’t have access to the information to say whether or not these plans are good or bad.

If you buy a medical plan, you can choose to buy a dental plan as well (you cannot buy dental without buying medical).

Your options are two plans: Dentcare and Healthplex.

The two plans look very similar – and are both administered by HealthPlex, it’s unclear what the difference actually is – both cost $11 per month, both are only usable at in-network Healthplex providers, and both have a $48 per-visit copayment.

The graphic below shows a side by side comparison:

 

We looked into Dentcare Plan details:

And we looked into the Healthplex Details:

On the surface, the plans look great.

Everything is covered 100%, including cleanings, fillings, root canals, and crowns, and with your cost being no more than $48 per visit, up to $480 per year.

As it is laid out above, everything is covered 100%, including cleanings, fillings, root canals, and crowns, and with your cost being no more than $48 per visit, up to $480 per year.

Sounds too good to be true? We thought so too.

Under the plans’ descriptions, it says “Plan follows NYS MMIS Guidelines’.

What does that mean?

It means that these are Medicaid plans.

NYS Medicaid is not like the typical dental insurance that you may have had through your employer. It has coverage limits not typically found in commercial insurance policies – which is understandable, as it is designed to help with basic dental care for the poorest members of our society.

For example, crowns are not covered.

Root canals are covered for front teeth only.

Only silver fillings are covered – and at very low rates.

Cleanings are covered, but at such low rates, expect to spend no more than 10-15 minutes in the hygienist’s chair.

This is not the type of care we provide to our patients – and this is not the type of care our patients have come to expect from their dentist.

We also do not believe these plans would result in substantial savings for our patients.

If the treatment is being billed per visit, and not per-procedure, we can foresee some very extended treatment times for procedures that normally take a visit or two. Instead of having multiple fillings done in one visit, the patient may have to come back multiple times, having only one filling done at a time.

While unfair to the patient, this may be the only way the participating dentists may afford to provide care at very low rates.

The other dental option is to buy a medical plan with Child only Dental Coverage.

There are very few details provided for these plans.

From what we can decipher, it seems that all of these plans are HMO- and Medicaid type plans. Unfortunately, these plans have the same problems as the Adult Medicaid plans – few things are covered, most at very low rates, and quality care is simply impossible.

None of these plans offer any coverage to adults.

We had really hoped the ACA would provide dental coverage for the millions of Americans who desperately need it. But the reality is, in New York State, all it did was extend Medicaid-level dental care to people with higher incomes. Given how restrictive Medicaid dental benefits are, it will be difficult to convince many dental offices to accept it, and the result will likely be millions of frustrated patients who are unable to find a dental office to accept their plan, or are unsatisfied with the level of dental care they would receive.

From the details provided, it is very unlikely that we, and other dental practices like us, will be able to participate. It is not possible to provide modern, gentle, painless dental care with these plans. In order to participate in these plans, we would have to make sacrifices to the level of care and service that would not be appreciated by our patients.

In our honest opinion, the Dental Insurance offered with ACA should really not be considered an option, even for those who are currently uninsured.

We understand that many of our patients need help paying for their dental care. We try to do our part by keeping our fees reasonable, and offering multiple payment options – while supporting NYS Dental Association efforts to lobby for a more comprehensive solution for our uninsured patients.

We hope this review was helpful to you!