SHOP to offer dental choice

In 2016, employers will be able to offer employees a choice of health and dental plans


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In 2014, nearly 2,700 citizens in New Hampshire acquired dental coverage from Delta Dental Plan of New Hampshire through HealthCare.Gov. About 75 percent of them did not have coverage before.

In the dental health arena, people with dental insurance go to the dentist far more often than people without coverage, so HealthCare.Gov has definitely helped access to dental care. We expect this positive trend to continue in 2015 and beyond in the individual market.

Looking ahead, employers and employees shopping for 2016 health and dental plans on the SHOP (Small Business Health Options Program) marketplace will find it is not the marketplace of old. In 2016, employers will be able to offer employees a choice of health and dental plans, which is the long-awaited “Employee Choice” feature that was originally intended to be in effect when the Affordable Care Act’s marketplaces rolled out in the fall of 2013.

Employers providing medical coverage through SHOP can elect to offer employees a choice of all carriers’ health plans at one level of coverage (platinum, gold, silver or bronze) or select one health plan to offer to employees. The same goes for dental coverage.

Employers with a small but diverse workforce may welcome giving their employees the ability to choose the plan that meets their individual needs best. Those employers will no longer be “the monkey in the middle” as before, when they were forced to pick a health plan that might suit one employee’s preferences but not another’s.

Next year will bring another new function to the SHOP. Employers will be able to offer dental coverage to employees without also having to offer medical coverage.

Small employers often find that many of their employees already have medical coverage, either through a spouse, a parent or the Medicare or Medicaid programs; this is especially true with more people delaying retirement past age 65. Other employees may want to purchase medical coverage on the ACA’s individual marketplace.

In 2016, a small employer that does not need or want to offer medical coverage to employees can offer just a stand-alone dental benefit plan to employees.

But it’s not all wine and roses on HealthCare.gov. The independent dental purchase option is not yet available on the individual marketplace, but it should be for those who only need or want to purchase dental coverage (for example, the more than 41 million seniors with Medicare, which does not cover dental services).

But beware: If you have purchased an individual medical plan and a stand-alone dental plan and are happy with your dental plan, but change your medical plan, your dental plan will terminate automatically, and without advance notice to you.

The U.S. Department of Health and Human Services is aware of this system problem, but the problem has not yet risen to the top of its “fix-it” list. But when the purchase of stand-alone dental plans is made completely independent of medical plan purchasing, HealthCare.gov may become more attractive to millions more potential users.

Tom Raffio is president and CEO of Concord-based Northeast Delta Dental.

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