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A Proposed Change to the ACA May Help Improve Access to Dental Care

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The Affordable Care Act (ACA) currently excludes adult dental care from its essential health benefits (EHB) in individual and small group plans, resulting in limited cost-sharing protections and coverage options for adults seeking dental care. Despite this exclusion, adults can still access dental coverage through stand-alone or embedded dental plans, though these often come with deductibles and out-of-pocket costs. A proposed change in the Centers for Medicare and Medicaid’s 2025 Department of Health and Human Services Benefit and Payment Parameters Notice aims to allow states to classify adult dental care as an EHB, potentially providing greater financial protection and access to care. Key issues to watch include the impact on consumers’ financial burdens, increased costs for federal government and health issuers, and potential effects on employer-sponsored plans. Implementing adult dental care as an EHB could enhance access to care, especially for lower-income adults, while addressing concerns about medical debt related to dental expenses. Click here to read more.

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