Washington State’s New Health-insurance Exchange will not Offer Adult Dental Care

In 2014, the Affordable Care Act health exchange in Washington will only offer children’s dental care but 2015 may see adult coverage.

For those who have already applied, Washington State’s new health-insurance exchange begins coverage on January 1st. However, the Healthplanfinder, like most other exchanges does not offer adult dental coverage. Children’s dental care will be included in plans on the exchange but a gap in coverage will remain for adults and seniors. This is especially true in Washington where nearly one-third of adults do not have dental coverage.

All small-employer and individual health plans must include 10 service categories under the Affordable Care Act but adult dental care is not included on the essential health benefits list. Fortunately, the essential benefits list includes dental coverage for children. Unfortunately, and some would say unfairly, Washington makes it mandatory to purchase children’s dental coverage whether you have children or not.

Washington is in the bottom 10 of all states rankings when it comes to dental care access for older adults, according to a report recently published by Oral Health America. Titled, “State of Decay: Are older Americans coming of age without oral health care?”, the report ranks states based on level of coverage for older adults in state Medicaid plans, community water fluoridation and total loss of teeth.

For 2014, the exchange does not consider adult oral care a top priority since it wants to start out with essential benefits and the federal government will not subsidize it, but it will be considered for 2015. On the bright side, about 450,000 eligible adults who lost dental coverage due to Medicaid budget cuts in 2011 will receive it again starting January 1st. To restore the coverage the state has transferred $23.3 million from the biennial budget.

Under the ACA Medicaid expansion, the state will receive an additional $49.2 million to cover newly eligible families. Adult dental insurance is important to put back into Medicaid, said Ron Inge, dental director for Delta Dental of Washington, because $60 million in emergency room costs for oral conditions have mounted up since the 2011 budget cuts. Likewise, emergency room costs for uninsured adults would rise with the lack of dental coverage through the exchange, he said.

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