What is the Problem with Adult Dental Insurance Plans on Healthcare.gov?
NEW YORK ( MainStreet) You may have heard that you can buy a new dental insurance plan via healthcare.gov as part of the Affordable Care Act (ACA). For kids 18 and under, pediatric dental is now one of those new essential health benefits insurers must include under the ACA. For those under 18, dental coverage comes with out-of-pocket maximums that limit the amount you need to contribute toward kids' dental costs, without a benefits cap, same as the new health insurance policies offered on healthcare.gov work. And that is great for kids' dental health.
What you probably haven't heard is the new adult dental plans offered on Healthcare.gov are no better than any dental plan you may have considered before the enactment of the ACA, whether privately or via a past employer's health benefits package.
Benefit caps on adult dental plans not openly listed
The problem is that you wouldn't understand your total possible costs from simply looking at the dental plan benefits shown on healthcare.gov's anonymous shopping tool, or even when logged-in to enroll, says Jonathan Wu, C.E.O. of Valuepenguin.com, a consumer finance site that specializes in helping consumers make decisions about insurance. He recently analyzed the way the plans are displayed and found some very misleading language when it comes to the adult dental plans.
"You can see all the plans offered but be completely deceived as to the true dental plan costs and benefits for adults," he warns.
Understand the wording or pay the price
If you've shopped for ACA health insurance, then you're familiar with the term "out-of-pocket maximum" which limits the amount a consumer has to pay per year. With a $700 out-of-pocket maximum, once you have spent $700 in copays, deductibles and coinsurance, the insurer picks up all additional costs.
But when it comes to adult dental insurance, both before and after the ACA, another term, "annual maximum" (also called the "benefits cap"), comes into play which limits the maximum amount the insurer has to pay. Unlike the health plans, an adult dental plan with a $1,000 annual maximum means that once the insurer has paid out $1,000 in benefits, you are responsible for all additional costs.
"Because there is no such benefits cap on new health insurance policies due to the ACA, consumers shopping for both health and dental might not realize there is an adult dental benefits cap, especially when it is not openly listed," says Wu. "You can only find a plan's adult dental benefits cap, called "annual maximum," by clicking on the actual plan brochure and looking through the benefits chart."
The only other tip-off Wu found that an adult might be responsible for paying more than that maximum-out-of-pocket cost is some wording you find just underneath, only when logged-in to the actual enrollment and plan selection page on healthcare.gov.