Thereās a lot of gray area when it comes to the implementation of the Patient Protection and Affordable Care Act (PPACA or āObamacareā) 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, āOrthodontia is one of the big coverage differences that may occur for pediatric dental.ā
Ireland states, āPediatric 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.ā
In effect, one of the biggest changes to dental coverage may entail how the categories of orthodontic needs are addressed. Because pediatric dental doesnāt include cosmetic ortho, things get muddy because the PPACA doesnāt actually define whatās included as ācosmetic orthoā. Although the original definition states that it includes medically necessary ortho, the government has yet to clarify specifics under Obamacare.
Obamacare, Dental Coverage and Your Kids
