It is open enrollment time, and it is important to understand some of the changes happening in regards to your medical and dental insurance coverage. Covered California has announced some changes to how dental benefits will be offered in the state exchange for 2015.
For 2015, California will now require all medical insurance companies that sell plans in the Covered California Exchange to now include and “embed” pediatric dental benefits.
While the California Dental Association (CDA) supports pediatric dental benefits being one of the ACA essential health benefits because it will ensure dental benefits to all children who get their insurance through the state exchange, the CDA has expressed concerns with having only medical plans offering the dental benefit and not having stand-alone dental plans because most of the medical plans have never offered dental plans in the past.
CDA reports critical questions remain about the operation and effectiveness of Covered California because of major past issues such as substantive problems with provider directories and the adequacy of provider networks. During the last open enrollment period, Covered California could not maintain an adequate list of the providers participating in each plan. This left the consumers to either attempt to contact each plan individually to figure out if their current doctor or dentist was a member of the network or to buy a plan without knowing which providers would be available for them.
In addition, the CDA reports that two medical plans sold under Covered California are under investigation by the Department of Managed Health Care (DMHC). The DMHC is investigating whether Anthem Blue Cross and Blue Shield of California violated state law by misleading consumers about the size and specific make-up of their provider networks and whether their “narrow networks” made it too difficult for policy holders to get timely care.
The CDA remains engaged and advocating in all of the statewide ACA implementation efforts.
-The above is a summary of the California Dental Association Column by CDA Public Policy Director Nicette Short, MPA Titled Covered California makes changes to dental benefits 2015, which was published in the November 2014 CDA Update.
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–Dr. Jon and Team HappyHealthyTeeth