Dental care could soon become more accessible for adults purchasing health insurance on the Affordable Care Act (ACA) marketplaces, as the Biden administration proposes a significant shift to narrow the existing coverage gap in the 2010 health care law. This move is particularly crucial as oral health is closely linked to overall well-being, with conditions like gum disease having implications for cardiovascular and diabetes issues.
Closing the Coverage Gap: A Step Towards Comprehensive Care
The Centers for Medicare and Medicaid Services (CMS) recently introduced a proposal that would empower states to designate adult dental services as an “essential health benefit” (EHB) in ACA health plans. This means that ACA plans would need to cover dental services without imposing annual or lifetime limits, a change that could have far-reaching benefits for individuals, especially those with lower incomes and people of color who are more likely to face oral health challenges.
Revisiting EHB Standards: A Shift in Perspective
The proposal marks a departure from the initial EHB standards set over a decade ago when adult dental care was excluded based on the structure of employer health plans. The current administration acknowledges the significant impact of oral health on overall well-being and quality of life, prompting a reevaluation of the government’s earlier stance.
Making Coverage More Accessible and Generous
While all states currently offer at least one adult dental coverage option on the marketplace, designating dental coverage as “essential” would enhance accessibility and generosity. The CMS proposal allows dental coverage to be integrated into medical coverage or offered as a standalone plan, offering flexibility in how states structure their offerings.
Public Response and Future Implications
Consumer advocacy organizations, including Families USA, have lauded the proposal, recognizing it as a pivotal moment in advancing the conversation around oral health. The move aligns with a broader strategic plan laid out by CMS last year to improve coverage and access to oral health care. However, the extent to which states will adopt this change remains uncertain, with considerations about its impact on insurance costs.
Looking Ahead: Potential Implementation in 2025
If the proposal is finalized, states will have the option to add dental coverage as an essential benefit starting in 2025. This shift is part of ongoing efforts to address disparities in oral health care, particularly in government coverage programs where adult dental benefits are not universally covered.
Comprehensive Approach to Health: Beyond Dental Care
The Biden administration’s initiative aligns with a broader effort to enhance the overall health of individuals by recognizing the integral role oral health plays in comprehensive care. As discussions around healthcare reform continue, bridging the gap in dental coverage represents a step towards a more inclusive and holistic healthcare approach.
Erin Balsa is a highly skilled and knowledgeable health journalist with a passion for educating the public on important health and wellness topics. With extensive experience in both traditional and digital media, Erin has established herself as a trusted voice in the field.