ADA pushes for dental as an essential health benefit, dental loss ratio

The American Dental Association showed its support for the removal of a current prohibition of adult dental coverage proposed by CMS.

Dental coverage could be included as an essential health benefit because of the impact that oral health issues can potentially have on other chronic medical conditions, according to a Jan. 9 news release from the ADA. The ACA requires plans on the individual and small-group marketplaces to include coverage for essential health benefits. 

In its letter to CMS, the ADA claimed that adults should have access to dental benefits through either a qualified health plan or stand-alone plan, and states should put consumer protections in place, such as cost sharing, plan limits and out-of-pocket maximums.

The ADA asserted that the categories for an essential health benefit benchmark plan for adult dental services should include diagnostic, preventive, emergency care, restorative, oral and maxillofacial surgery, endodontics, periodontics, prosthodontics and orthodontics. 

The organization also suggested that CMS and HHS create a specific loss ratio for dental plans. Currently, qualified health plans for medical insurance must not spend more than 20% of premiums on administrative expenses. 

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.