Factors affecting the Affordable Care Act Marketplace stand‐alone pediatric dental plan premiums

Abstract

Background: Children from lower income families have inadequate dental insurance coverage and poorer dental health in the United States. The Affordable Care Act (ACA) created Health Insurance Exchange Marketplaces to increase competition among health insurers and to provide low-income families with less costly health plans. The study examined Marketplace pediatric stand-alone dental plans (SADPs) and factors that affect their premiums. Methods: The data used were 2016 Federal-Facilitated and State-Partnership Marketplace pediatric SADP data. Ordinary least squares regressions were applied to estimate contributing factors’ effects on SADP premiums. Results: Great premium variation was found among low and high coverage level SADPs, respectively. Premiums of Health Maintenance Organization (HMO) SADPs were significantly less expensive than Preferred Provider Organization (PPO) SADPs. SADPs charged significantly higher premiums for more types of services covered. SADPs also charged higher premiums in states where there are larger proportions of low-income people who report poor dental health, more dentists per capita, or higher dentists’ wages. The number of insurance companies offering pediatric SADPs in a Marketplace was negatively associated with premiums. Conclusion: The current Marketplace pediatric SADPs may have limited effects on increasing economically disadvantaged children’s access to quality dental care. Marketplaces can promote competition among its pediatric dental insurers on providing lower-cost pediatric SADPs.

Adverse childhood experiences, dental insurance, and developmental disability: Association with unmet dental needs in Ohio

“…(40) Essential benefits are only required to be included for individual and small group business plans that are sold through the Insurance Marketplaces created through the Affordable Care Act, so children covered by insurance obtained outside the Insurance Marketplaces may not have dental services as a benefit. The costs of these types of plans are often prohibitive for those who need them most, (41) which makes this solution less realistic.…”