Dental Articles for Individuals

Dental Articles for Individuals

What is the "Exchange"?

What is the "exchange"?

Healthcare reform is here, and a lot of people have important questions about how it affects them and what they may need to do to starting January 1, 2014. The simple answer for individuals is that if you currently have a medical plan (either with your employer or an individual policy), you do not need to do anything. For individuals who do not currently have medical insurance, the individual mandate will require you to purchase insurance for yourself (and dependents) or pay a tax (the insurance mandate only applies to medical insurance, not dental insurance. You are not required by law to have dental insurance). But the law is also intended to make buying medical insurance easier, and therefore we have the healthcare exchange.

The healthcare exchange is an online marketplace created to provide the public with individual healthcare plans. The plans on the exchange meet the new standards that healthcare reform requires. Each state is responsible for either creating their own state-run exchange OR being part federal government exchange. On the exchange, you will find medical insurance plans and dental insurance plans offered by private companies that are available in your state. In addition to being a one-stop shop for insurance, the exchange also provides subsidies to make buying medical insurance easier for those with low incomes.

State Exchange Websites (as of 10/15/13):

Federal Health Exchange:

Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, South Carolina, Tennessee, Texas, Utah, West Virginia, Wisconsin, Wyoming

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Will dental therapists gain acceptance in California?

Dental therapists receive specialized training that allows them to administer local anesthesia, perform x-rays, exams, fill cavities, pull teeth and even perform root canals. With nearly 17 million children in the country currently lacking basic dental care, dental therapists are expected to help fill the existing gap in dental care and coverage.

The majority of the children and their families do not have California dental insurance. They tend to live in areas without enough dentists or they simply can't find members of the dental community who accept Medicaid. Problems accessing dentists in California could grow dramatically in 2014 when millions of more children are expected to get dental insurance under the (ACA) Affordable Care Act.

The (ADA) American Dental Association argues that dental therapists aren't adequately trained to perform the major dental work that has typically been performed by fully licensed and trained dentists. Dental lobbies in California are arguing that high school graduates with a few years of training could end up performing delicate procedures with permanent and irreversible consequences if done incorrectly.

The Children's Dental Campaign for the Pew Center on the States, and other research and advocacy groups counter that concerns about insufficient training and substandard quality are completely unfounded and are just an anticipated reaction from dental association groups whose main purpose is to protect the incomes and livelihoods of existing dentists.

They say that the therapists would be properly trained, educated, and supervised to help close the huge and growing gaps in dental care which are causing an oral health disease epidemic across the country today. Nationwide, nearly 830,000 emergency room visits in 2009 were due to preventable dental problems, according to the center. The amount of money, pain, and suffering saved by eliminating most of those visits not to mention the increase in productivity of those effected could make a real difference in thousands of families and businesses across the country.

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Three million more children could have dental insurance by 2018

A recent ADA News story on the potential effects of the (ACA) Affordable Care Act on dentistry stated that an estimated 3 million children will gain dental benefits by 2018 through health insurance exchanges, roughly a 5 percent increase over the number of children with private benefits currently. 

Beyond the exchanges, more children will benefit through employer-sponsored dental benefits with dependent coverage, "although the number is uncertain at this time," the Association said.  

The law includes pediatric dental coverage in a list of essential health benefits to be provided by small and individual group health plans. The ACA does not address coverage for adult dental benefits. However, some states are looking at adult coverage as a potential optional benefit after the ACA-mandated health benefit exchanges are in place.

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