Know the drill on health insurance marketplaces

142030139Questions about dental insurance on the marketplace? Get to know the drill.

For the first 21 years of my life, I did not have dental insurance. I just paid out-of-pocket costs whenever I needed care. For me, this wasn’t an issue because I took care of my teeth and thankfully didn’t have many problems. I always assumed, however, that if a problem ever did arise, getting the information on how to get dental insurance would be as simple as asking my dentist.

That was not the case. The other week, I approached my dentist about shopping for dental coverage and was surprised when he wasn’t clear on what options were available to me. He recommended one external insurer but knew very little else. If I chose not to enroll through that insurer or in his family plan, my only option was to pay out-of-pocket for my appointment. Our interaction made me realize both how beneficial the Health Insurance Marketplace is for people like me, and how many people – providers included – are unaware of those benefits.

The Affordable Care Act (ACA) created online Health Insurance Marketplaces to help people buy health insurance, including dental insurance. Depending on your state, you can get dental coverage in the marketplace in one of two ways: as a part of a health plan, or through a separate, stand-alone plan. Connecticut is one of the few states that offers pediatric dental with all of its health plans. Under the law, insurers are required to offer pediatric dental insurance, but neither adults nor children are required to purchase it.

Nearly 7.3 million people have bought health insurance through marketplaces so far this year. Yet, the National Association of Dental Plans reports that 126.7 million Americans nationwide still do not have dental coverage. Those without dental insurance are more likely to ignore dental problems instead of seeking care due to the steep out-of-pocket treatment costs. At the same time, they are reported to more likely have extractions, dentures, and higher incidences of other illnesses. Studies have shown that those without dental coverage are 67 percent more likely to have heart disease and 50 percent more likely to have osteoporosis. (source)

The online marketplace is a useful tool to combat these statistics, especially for those without insurance through an employer and with incomes too high to qualify for Medicaid. The marketplace provides consumers with a platform to compare prices and shop for the dental plan that fits their needs. Ultimately, it changed access to dental coverage for many people. Although opened around the country over a year ago, the marketplace is still unfamiliar territory for many, including dentists like mine.

The improvements in the new insurance landscape will remain unused without people to inform the uninsured population. As students, you should prepare for your profession by doing the research on your state’s marketplace so you have a basic understanding of the system and can inform patients when applicable.

Had a similar experience with dental insurance? Or a completely opposite one? Comment and share your thoughts below.

Lynn Doan, Colorado College ’14, predental

Lynn Doan

Lynn Doan is currently working as a Project Coordinator for diverse oral health initiatives in Colorado. She is passionate about health equity and personalized greeting cards. Lynn will start dental school at the University of Colorado School of Dental Medicine Fall of 2016.

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  1. While running errands at our local 7 stores, my significant other and I talked about insurance coverage. We compared our insurance rates and what they covered. Essentially our insurance covered the same expenses except he had to meet a ridiculous deductible. He’s never used his insurance before and the emergency room has been my second home this past year yet I do not pay nearly as much for all my ER visits as he does in a month. Dental is another thing. His insurance does not cover dental and my insurance includes dental. It is true that if you aren’t covered with dental insurance that people are less likely to visit their dentist for check-ups. It is very expensive out of pocket. I have yet to use my dental insurance but plan on in the near future. Research. Research. Research before choosing is my advice.

    Thanks Lynn for the awesome article!

  2. Thanks for the article. Doing your homework is essential. Several people who have signed up and paid for for dental insurance through the Marketplace have found that ALL of their dental care including preventive care is subject to extremely high deductibles. What an disappointing and expensive surprise for them! The research on this topic will continue and offices like ours will continue to try to keep up with the latest changes to be able to help our patients make informed decisions about dental insurance. For more information…check out:

    1. Lynn Doan says:

      I completely agree! Your blog does a great job of outlining the important questions consumers need to consider. You mentioned that people should do the math on how much dental care they will be need before purchasing a plan. I’d also like to add that it’s important to compare that to how much medical care your family might need. For example, if your family needs expensive medical care (e.g. chronic illness, expensive medications), you may want to buy a plan that includes medical and dental care (embedded), so that all of your spending counts towards the plan’s one out-of-pocket limit. That way, your plan will start paying the full cost of your care sooner.

      Thank you for sharing. It’s great to see dental offices, like Cornelia Dental, help consumers find affordable care and actually USE it.

  3. That’s a great thing to keep in mind! We have been trained to think of medical and dental insurance as totally separate…so it will be interesting to try to keep up with the changes.

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