Carmel Valley Dentist – ObamaCare and Dentistry

Dental practices and the public alike are navigating the maze of the Affordable Care Act  (ACA) also known as ObamaCare and how its healthcare mandates relate to dentistry.  As part of the ACA, dental care for children is cited as one of the 10 essential health benefits, but the reality is that pediatric dental plans may be optional.  For children who have dental coverage, under ObamaCare, pediatric dental plans allow for basic or expanded dental benefits and they also may include orthodontic coverage.

Many patients have asked me over the years about ObamaCare and how it will relate to dentistry.  The American Dental Association estimates that as many as 8.7 million children will gain some form of dental benefits by 2018 as a result of the ACA, and a  total of 17.7 million adults are also projected the same dental benefits as a result of the ACA.

Many patients ask me will dental coverage be a part of medical insurance plans?  Since pediatric dental care is required under the ACA, basic dental coverage will be included in some health plans.  In most cases, however, separate, stand alone dental plans will be offered for basic dental services and preventive care.  In fact 99% of dental benefits are sold under a policy that is separate from medical coverage and this is not expected to change significantly.

Stand alone dental plans are likely to have much lower deductible than medical plans that also include a child dental care, or possibly no deductible, according to Delta Dental.  They are also likely to have lower limits on out of pocket expenses than plans that combine medical and pediatric dental care.  This may benefit families of children with acute dental care needs as well as those who want paid preventive care without having to wait until they have spent enough money to meet a higher deductible.

Unlike the medical component which is mandated by our government, dental is not required.  Patients will still have an out of pocket expense under the ACA and this will not count towards your medical out-of-pocket limits.  It is also unclear which dentists will be accepting dental ACA.  Currently dentists accepting Medicaid and Medicare will, most likely, be mandated to accept ACA dental patients, but as far as a wider range of options for patients remains unclear since the ACA has not formally organized a fee schedule to present to the dental community.

Navigating through the ins and outs of the ACA may be challenging and we will probably learn more once the law is implemented.  Most of our patients will remain on their employer’s dental plans.  As those plans start to shift towards plans under the ACA, patients must be weary of what the options for them might be.  Inform your employers that you do not want to see dental go the way of medicine.  Let them know that you, as the employees, want your dental plans to be separate from medical plans.  Simply observe the fiasco that is occurring at the VA Hospitals now and ask yourself how many weeks you would like to wait to have a toothache addressed?
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Born and raised in San Diego, Dr. James Tasto attended University of San Diego High School where he lettered in both golf and wrestling. After earning a Bachelors in Science from Loyola Marymount University, Dr. Tasto graduated from University of Southern California Dental School with an emphasis on cosmetics and sports dentistry.  Dr. James Tasto was selected by his peers to be included in the List of Top Dentists in San Diego for 2007 – 2013.  He appeared in the May issue of San Diego Magazine.  Dr. Tasto is also a member of D.O.C.S. (Doctors Offering Charitable Services), a local organization that offers medical services such as plastic surgery, vision and dental to the less fortunate patients in San Diego.  Dr. Tasto currently resides in San Diego with his lovely wife Traci and their 3 children. He enjoys golf, beach volleyball and playing with his kids.