Dental Insurance News: Understanding Recent Changes

Dental insurance news can be overwhelming, but understanding recent changes can help you make informed decisions about your coverage. Many dental insurance plans now cover routine cleanings and exams, often with no out-of-pocket costs.

In 2022, the American Dental Association (ADA) reported that 90% of dental insurance plans cover preventive care, such as cleanings and exams. This shift in coverage is a significant change from previous years.

Some plans now also offer more comprehensive coverage for restorative services, including fillings and crowns. For example, a plan may cover 80% of the cost for a filling, with the patient responsible for the remaining 20%.

As a result of these changes, many people are finding that their dental insurance plans are more comprehensive and affordable.

Dental insurance options are changing, and it's essential to understand the implications. Embedded deductibles might not provide consumers with financial protection for dental care, as medical deductibles can be thousands of dollars.

If a state chooses to offer adult dental care as an Essential Health Benefit (EHB), medical plans would be required to cover it, and the medical deductible could apply. This could deter consumers from seeking dental care, especially those with lower incomes.

The new provision could affect employer-sponsored plans, particularly small employer plans, which are required to cover EHBs. Large employer plans that choose a state benchmark plan with adult dental care as an EHB would also be required to abide by the cost-sharing requirements.

Here are some key points to consider:

Pregnant members can take advantage of MCNA's Bright Beginnings program, which offers a free dental kit with oral health care supplies.

This kit includes information about good oral health for moms and babies, helping new parents establish healthy habits from the start.

The program recognizes the importance of oral health during pregnancy, and provides a valuable resource for expectant mothers to prioritize their own and their baby's dental well-being.

Embedded deductibles in medical plans might not provide financial protection for dental care, as consumers may have to meet the medical deductible before coverage of dental services can begin. This can be a significant issue, especially for people with lower incomes who may not be able to afford thousands of dollars in deductibles.

Dental care could become more expensive for the federal government and health issuers if states choose to offer adult dental care as an Essential Health Benefit (EHB). The federal government might see an increase in costs due to the application of advanced premium tax credits towards dental care.

Small employer plans, like those in the individual market, would be required to cover EHBs, including adult dental care, if a state chooses to offer it. However, large employer plans do not have to meet EHB rules, but they would still need to comply with the ACA's prohibition on annual and lifetime dollar limits.

Consumers might be subject to cost-sharing for routine preventive dental services, such as cleanings, or be required to meet the deductible before coverage of preventive services began. This is because no adult dental services have received an A or B rating from the United States Preventive Service Task Force recommendations.

Some employer plans that offered dental plans separately as "excepted benefits" might not be required to abide by the cost-sharing requirements that apply to other EHBs.

MCNA has a strong commitment to quality and service, as evidenced by its accreditation from URAC, the first dental plan in the country to receive full URAC Dental Plan Accreditation.

This accreditation demonstrates MCNA's dedication to quality improvement and outstanding service.

MCNA has also earned National Committee for Quality Assurance (NCQA) Accreditation in Credentialing and Recredentialing, ensuring that dental provider networks are maintained with only qualified dentists.

Pennsylvania and Illinois have recently passed legislation related to dental benefits, joining 10 other states in doing so.

Dental insurers in Pennsylvania are now prohibited from using only virtual credit cards for claim payments, which is a major victory for dentists.

The Pennsylvania Dental Association's government relations committee, led by Darleen Oleski, D.M.D., worked tirelessly to pass House Bill 1664, which requires insurers to provide notice to participating dentists of all payment options.

Dentists in Pennsylvania will now have more flexibility in accepting payments from their patients, which can help streamline their practice.

Under House Bill 4789 in Illinois, insurance companies cannot deny claims for procedures specifically included in a prior authorization unless certain circumstances apply.

This new law aims to prevent insurance companies from denying coverage for necessary treatments, such as reconstructive surgery and dental implants, as in the case of an Illinois resident undergoing treatment for jaw cancer.

SB 3305 in Illinois requires health insurers to cover medically necessary care and treatment for major jaw injuries caused by accident or disease, including oral and facial surgery, dental implants, and prosthetics.

MCNA has earned National Committee for Quality Assurance (NCQA) Accreditation in Credentialing and Recredentialing.

This ensures we maintain dental provider networks with only qualified dentists to provide excellent oral health care.

MCNA is committed to quality improvement and outstanding service, as demonstrated by its accreditation.

Visit the NCQA website for more information.

Arkansas Medicaid and CHIP covers many of the costs of routine and preventive dental care, qualifying based on family income.

You can download your Member Handbook to see a full list of your covered services, which include preventive, diagnostic, and therapeutic services.

According to the 2023 KFF Employer Health Benefits Survey, 90% of small firms and 94% of large firms offer dental insurance programs to their employees, showing a strong trend of employers prioritizing dental care.

You'll be notified by the State of Arkansas that you've been assigned to one of two insurance companies to manage your dental needs.

If you're assigned to MCNA Dental, you'll automatically have access to great dental care.

You'll also be eligible to claim an Amazon.com Gift Card after your first preventive dental visit.

Call the Member Hotline if you have any questions or need help with enrollment.

You qualify for dental services through Arkansas Medicaid and CHIP based on your family's income, which helps cover the costs of routine and preventive dental care.

These services are designed to ensure you have healthy teeth and a beautiful smile.

Routine and preventive dental care are just the beginning, as your coverage also includes many other preventive, diagnostic, and therapeutic services.

To see a full list of your covered services, you can download your Member Handbook.

Arkansas Medicaid and CHIP dental coverage with MCNA offers extra benefits and services that go beyond just routine care.

Dental care is often subject to a deductible, but many plans waive it for preventive care like cleanings.

The average deductible for standalone dental plans offered on the individual market in 2023 was $47, which is significantly lower than the average medical deductible of $3,057 in 2024.

High out-of-pocket costs can lead to delayed dental care, with at least one in four adults with health insurance reporting cost barriers to accessing dental care in the past year.

The Arkansas Medicaid Program is undergoing some significant changes. This fall, the program will change the way dental services are paid for.

Children and adults covered by Arkansas Medicaid will be affected by these changes. They can learn more about what it means for them by reading the special message at the beginning of MCNA's Arkansas Member Handbook.

The exact details of the changes are outlined in the handbook, but one thing is certain: this change will impact those who rely on Medicaid for dental care.

Adult dental care is an essential health benefit for children under 18, but not for adults, due to a regulation prohibiting it from being considered an essential health benefit under the ACA statute. This means adult dental care is excluded from major cost-sharing protections and premium subsidies.

The average deductible for standalone dental plans offered on the individual market in 2023 was $47. In contrast, the average deductible for medical plans that include dental coverage was $3,057 in 2024.

Many dental plans waive the deductible for preventive dental care, such as cleanings, or cover preventive care 100%. This is a relief for consumers who can get necessary care without breaking the bank.

At least one in four adults with health insurance report cost barriers to accessing dental care in the past year, including those with Medicaid, Marketplace coverage, ESI, and Medicare.