As the dust settles following the passage of the Patient Protection and Affordable Care Act (PPACA), health care professionals continue to have questions and concerns, but one fact remains constant: nothing is certain. 

According to the National Association of Dental Plans (NADP), future regulations by the U.S. Department of Health and Human Services (HHS), and other federal agencies could result in significant changes to the current interpretation of health care reform. What we do know now is:

Mandated Coverage and Exchanges
The PPACA mandates that every American have coverage and that state exchanges be created so small businesses and individuals can purchase coverage through the exchange mechanism or the private market. For dental insurance, this includes pediatric oral health services within the small group and individual markets. Larger group employers are not required to offer children’s dental coverage unless the group receives coverage through a state exchange. States will have the option to allow large groups to enter their exchanges starting in 2017.

Minimum and Essential Coverages
Beginning in 2014, PPACA will require every American to have minimum essential coverage or face tax penalties. Minimum essential coverage does not require distinct benefits, but does allow coverage from most current and future programs, including inside or outside the exchanges, employer groups or government programs.

PPACA also has some requirements for large employer coverage, such as meeting the floor of 60% actuarial value for coverage, but specific benefits are not yet defined.

PPACA will create and require an essential health benefits package for coverage offered in the small group and individual markets (inside and outside state exchanges). This “package”, which includes pediatric vision and oral health services, will be required starting in 2014 for the benefit plans offered in the individual and small group markets. 

Going Forward
In 2016, states will be required to change (if necessary) their definition of small group to include 100 or fewer employees.

While the large group market is not required to change its current benefit structure, changes in small group and exchange coverage could influence large groups or the products offered by carriers.

Overall, 97% of dental coverage is provided in separate policies. According to the NADP/DDPA 2009 Enrollment Survey, 55% of all consumers receive their dental coverage through large group employers while small groups and individuals make up only 32% of the market.

Stay Informed
To keep up on the dental benefits industry and health care reform, subscribe to the free, weekly industry e-newsletter, NADP Smartbrief and continue to read NADP updates in Guardian Pulse.