Dental Coverage and the Affordable Care Act

Laird Harrison


December 05, 2012

In This Article

Risk-Based Coverage for Children

Meanwhile, the Children's Dental Health Project, which was active in lobbying to include dental benefits for children in the ACA, has another idea for lowering the cost of dental insurance for children: Why not provide benefits based on a child's risk for dental disease?

Such a model has long been suggested by the California Dental Association, the ADA, and leading experts in the field. The argument is that some patients run a much greater risk for dental disease (the research so far has focused mostly on caries), and these patients should get more aggressive preventive treatments such as fluoride varnish, sealants, and more frequent cleanings. In theory, the approach should bring down the cost of insurance by reducing the number of expensive procedures, such as restorations, that insurance companies have to cover.

Ireland acknowledges that the current standard -- everyone should see a dentist twice a year -- has no basis in science. But she said patients now feel entitled to 2 visits a year, and they will feel cheated if only 1 annual visit is covered by insurance whereas someone else has 4 visits covered. "There would be consumer pushback to paying the same amount for what they would perceive as less treatment," she said.