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Site not clear on dental benefits for kids

COLLEGE PARK — Oral health advocates say Maryland’s health insurance exchange and insurance providers are not doing enough to inform consumers about children’s dental benefits guaranteed by the Affordable Care Act.

Potential enrollees are unable to view detailed information about what dental benefits are included in a medical care plan until they purchase it, making comparison shopping on the state’s health exchange website difficult.

The brief descriptions of dental care offerings on the site are misleading, said Colin Reusch, the senior policy analyst for the Children’s Dental Health Project, because insured children ages 19 or younger are guaranteed more than just a simple check-up.

“I think the full plan information should be readily available to consumers, even if they’re just window shopping,” Reusch said.

According to the state’s Medicaid dental program, Maryland Healthy Smiles, all insured children in Maryland are entitled to a regular check-up, bitewing X-rays, and a teeth cleaning every six months, as well as fillings, crowns, root canals, deep cleanings, dentures, extractions, medically necessary orthodontic work and dental anesthesia as needed.

CareFirst indicates only that dental check-ups are included for children, while Kaiser Permanente and UnitedHealthcare specify how many oral evaluations, cleanings and x-rays are covered by their plans, according to the plan comparisons on the Maryland Health Connection website.

Evergreen Health does not provide pediatric dental care through the Maryland Health Connection but encourages consumers to buy stand-alone plans or purchase insurance directly from Evergreen Health.

Kaiser Permanente, UnitedHealthcare and Evergreen Health could not be reached for comment. A spokesman for CareFirst could not comment on why coverage details were not listed in the plan comparisons on the exchange site.

“Unfortunately, the summary of benefits was a form developed at the federal level and did not require plans to report more specific information with pediatric benefits,” Reusch said. “They don’t say cavities and orthodontic treatment, and that is important information for consumers to know.”

Even when consumers create accounts on the state exchange site, they can only see whether basic or major dental care, checkups, medically necessary orthodontia, accidental dental care or dental anesthesia are covered.

Additionally, consumers who wish to buy stand-alone dental plans cannot review their full benefits until they establish an account.

It is only when consumers purchase a health insurance plan and receive a contract from their insurance provider that they can see a complete list of services included in their dental benefit.

Leigh Cobb, the health policy director for Advocates for Children and Youth, said that glitches in the online marketplace make it even more necessary to provide detailed information in the plan comparisons.

“It should absolutely have the apples-to-apples comparison, as opposed to what you’re seeing on the front end, and that is what people are using at this point,” Cobb said. “It’s very difficult to compare and it is critically important that people are able to compare what is offered plan-to-plan.”

Salliann Alborn, the CEO of Maryland Community Health System, an organization that provides support services for community clinics, said that even if the benefit details are not available before consumers enter the marketplace, insurance providers are required to disclose this information.

“What the Maryland Health Connection attempted to do was just put some basic information on the site so you could see it in brief before you had to get a user account or talk to a navigator,” Alborn said, adding that insurance providers should make the details of pediatric dental care clear so consumers understand what they are purchasing.

She said the limited benefit information is due in part to the design of the Maryland Health Connection marketplace.

“I think the reality is how you purchase insurance is not really up to the insurance companies. The design of how you make your purchase on the exchange was determined by the exchange,” she said.

Some insurance providers list specific details about the pediatric dental services they cover on their own websites. CareFirst published a guide for its consumer health insurance plans that categorizes the different types of dental services by how much members must pay out of pocket.

Scott Graham, a spokesman for CareFirst, confirmed that CareFirst plans offered through the Maryland Health Connection cover teeth cleanings, X-rays and fillings at no charge in accordance with the Maryland Healthy Smiles standards. Medically necessary orthodontic work required preauthorization, he added.

Additionally, the Maryland Insurance Administration published sample contracts for each of the qualified health plans and stand-alone plans that list all of the covered pediatric dental services.

Although detailed information is available through the state’s insurance administration, Reusch said the Maryland Health Benefit Exchange must make this information available where consumers are looking for information on health insurance plans — the Maryland Health Connection website.

“I think it’s important for consumers to have the full picture of what is offered through these plans and they should be fully aware of that, if they have a kid, they are entitled to the full services as an essential benefit,” he said.

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