Covered California delays adult dental options

This article orginally appeared in the U-T San Diego.

California adults hoping to purchase dental coverage through Covered California will have to wait until next year – or later – due to problems with the agency’s computer system.  

“We do not anticipate there will be adult dental added in 2015. We’re looking at that in 2016,” Peter Lee, executive director of Covered California, said at a recent press conference.

Covered California, the state’s health insurance exchange, originally announced in August its plan to offer standalone dental coverage for adults and families that could be purchased separately from health plans.

The dental plans were expected to be available during the open enrollment period that ends Sunday. Covered California attributed its decision not to offer the adult plans this year to “challenges in aligning family dental enrollment within the existing online system. 

Dental coverage up to age 19 is one of the ten essential health benefits that insurance policies are required to provide under the Affordable Care Act (ACA). Such benefits were embedded in health plans that were offered on the exchange this year, and therefore can be subsidized with tax credits depending on family income. Subsidies are not available for adult and family plans.

Nevertheless, five companies were preparing to offer adult dental plans through the Covered California exchange. That would have allowed consumers to make direct comparisons, and theoretically might lead to lower premiums or expanded coverage for Californians.

The delay is a “missed opportunity,” said Jeff Album, Vice President of Public and Government Affairs for Delta Dental, one of the companies that had planned to offer coverage.

“Delta Dental has urged Covered California to offer standalone pediatric and adult dental coverage from the very inception of the ACA,” Album said.

“So naturally, we were very disappointed to learn that for the second year in a row CalHEERS (the Covered California web portal) is unable to offer family dental plans, as most other states have been doing since 2014.”  

Now some Californians will need to look for dental insurance on the private market, or forgo it entirely.

Carrie Stoermer, 37, a freelance copy editor in Bonsall, recently lost medical and dental insurance through her husband’s employer.

She was able to purchase a health plan through Covered California, but the exchange’s announcement has left her without dental coverage.

Stoermer has looked for private dental insurance, but hasn’t been satisfied with what she has found.

“Since the plans I have seen so far have a six-month waiting period before you can use your benefits, I may as well wait until Covered California offers a more affordable option and pay out of pocket in the meantime,” Stoermer said.

“Had I known it was about to end, I would have seen a dentist before my previous coverage ended.”

When they become available, family dental plans will be sold during the regular open enrollment period. Consumers also will be able to purchase dental plans during a special enrollment period if they experience a qualifying life event, such as marriage or birth of a child.

“Once a consumer goes through eligibility determination for the health insurance portion they would then be offered the option of enrolling in a family dental plan,” said Roy Kennedy of Covered California.

But will the system issues be worked out in time for open enrollment next year?

“Covered California is confident the challenges can be overcome,” Kennedy said, “We’re committed to the family dental offering and it being an option for the 2016 plan year.”

Hellesen is a Sacramento-based reporter for the CHCF Center for Health Reporting.

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