The rollout of Obamacare: How it affects you and your mouth
SUMMARY: What dental care changes are coming your way under the Obamacare? Find out what it means for you and your kids.
Posted: September 11, 2013
Often, trying to understand the jargon within Obamacare can be like trying to understand a speech given by a kid who's wearing headgear, rubber bands and braces. You catch some words but can't quite make out the rest. So, let's clarify. A lot has been made of the politics behind it, but how does Obamacare impact you and your kids' oral health?
There are two groups that can sign up
Two groups are eligible: individuals and small business owners. That is, individuals who don't receive health coverage under their current employer already can enroll. Insurance will be made more affordable by federal subsidies, and tax credits will be used when you actually purchase the insurance. Sound confusing yet? Stay with it. If you earn less than 400 percent of federal poverty, which is $46,021 for an individual or $93,700 for a family, then you may be eligible to receive tax credits and subsidies on your State's Health Insurance Exchange.
However, the exception is for people whose employer's insurance is unaffordable, where the employer-sponsored health insurance is more than 9.5 percent of family's income, or whose plan doesn't reach minimum requirement of Obamacare. These people will be exempt from the tax "penalty."
Companies with less than 100 full-time employees can utilize the exchange to buy coverage for their workers (full-time is defined as 30 hours per week under the law).
Who can't sign up?
Those qualifying for Medicaid, CHIP or Medicare won't be eligible. In addition, the people who receive health insurance through their employer will continue to do so. They will likely see a small rise in premiums over the next few years.
When does it start?
Oct. 1 is the start date of the health insurance exchanges under the Affordable Care Act. It launches open enrollment that spans through next March. Importantly, coverage won't begin until Jan. 1, 2014.
There are four mains plans
Bronze: You pay 40 percent of healthcare costs, the insurance company pays 60.
Silver: You pay 30 percent, insurance company pays 70.
Gold: You pay 20 percent, insurance company pays 80.
Platinum: You pay 10 percent, insurance company pays 90.
Which plan you land on depends on the insurance company from whom you buy, your age, the number of people insured by the plan, where you live and whether or not you smoke.
How it affects the oral health of your kids
Everyone on all plans will get essential health benefits, which are services and items within 10 categories. "ambulatory patient services, emergency services; hospitalization; maternity and newborn care; mental health and substance us disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease manage; and pediatric services, including oral and vision care," according to HealthCare.gov.
Note that the last part does include oral care. Crucially, it is only directed toward oral health for kids, defined as to age 19. Obamacare covers all dental treatments for your children, so little Sandy will be able to get routine check-ups for cavities, dental plaque, fluoride treatments, etc.
How it affects your oral health
Obamacare does not provide the same coverage to adults. It requires consumers to buy health coverage, yet does not make dental coverage mandatory. This is worrying dentists.
"The ACA really falls short on adult coverage in dentistry," remarks president of American Dental Association Robert Faiella to Market Watch. "The dental side is not really addressed."
Although the program requires insurance companies to provide fluoride supplements for dental treatments if necessary, you might have to find a dental plan separate from Obamacare if you're looking for treatment on dental plaque and tooth filling among others.