There’s a lot of gray area when it comes to the implementation of the Patient Protection and Affordable Care Act (PPACA or “Obamacare”) and its effects on orthodontic reimbursement. One thing is certain, people are still going to need pediatric dental services but you may need to prepare for cost shifting if your kids need braces. According to Evelyn Ireland, Executive Director of the National Association of Dental Plans, “Orthodontia is one of the big coverage differences that may occur for pediatric dental.”

Ireland states, “Pediatric dental in the proposed rules is defined as any enrollee up to [age] 19, so the way [PPACA] is structured, pediatric dental is a benefit that is described as part of the essential health benefits that will be offered in the small group and individual market. Of course, the small group includes exchanges.”

In effect, one of the biggest changes to dental coverage may entail how the categories of orthodontic needs are addressed. Because pediatric dental doesn’t include cosmetic ortho, things get muddy because the PPACA doesn’t actually define what’s included as “cosmetic ortho”. Although the original definition states that it includes medically necessary ortho, the government has yet to clarify specifics under Obamacare.

In other words…

Sound confusing yet? Try to think about it this way. If 70% of people who currently get reimbursed for ortho now don’t get reimbursed, that creates a huge shift in coverage. Between birth and the age of 20, 18-19% of all children have some sort of orthodontic procedure done, so with these changes now only around 1/3 of those kids would be covered. All the rest wouldn’t have coverage under the Obamacare Essential Coverage Plan. That’s going to radically change the paradigm for expenses to not only you but for dentists as well.

The problem comes down to this; the existing system can’t really sustain any major cost shifting due to its already complicated and fragile makeup. If the government increases taxes on medical devices such as braces, the cost gets passed along to everyone, which of course usually doesn’t bode well for the common consumer.

Take Action

So before these changes are fully implemented, it may be time to address your own kids’ orthodontic needs while coverage still exists in its current form.

Dr. Hall offers Invisalign Braces which are a popular and cost-effect alternative to metal braces. Crooked teeth, teeth with small gaps and numerous other problems can be solved by Invisalign. Invisalign negates the lifestyle changes and metal accessories that come with traditional braces. Instead, patients are fitted with clear aligners that can be worn all the time. The aligners work to gradually move your teeth to the desired position and can be removed for cleaning at any time, but should be worn at least 22 hours every day. If you are considering braces come talk to Dr. Hall about Invisalign today.