Health reform: What about vision and dental?

This is an archived article that was published on in 2009, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Q: Will the new health care reform cover dental and vision services? And if so, what criteria will you have to meet to use those benefits?

- Lisa C., Salt Lake City

A: This is something everyone should want to know but it took a very special woman to raise this thought provoking yet practical question.

Thanks, Mom!

That's right, this question comes from my beloved Mother, who always made sure I brushed my teeth twice a day and who helped pick out my first pair of glasses when the blackboard looked a little fuzzy in the first grade.

Now the answer to your question Mom is completely age based, so we will explore the issue for children, adults and seniors.

Children » Insurance companies would be required to offer pediatric dental and vision coverage, under the House and Senate proposals.

These "essential benefits" would apply at first to plans offered through government-regulated exchanges, where people who are not covered through their jobs would buy coverage. Eventually, it would become the nationwide norm.

Adults » Much to the chagrin of dentists and optometrists, the bills remain silent on the issue of dental and vision coverage for adults. Some plans are likely to offer these services but they are not required to do so. Some states may decide to pay for vision and dental for those receiving Medicaid, but the federal government won't cover that. Utah has dropped those services.

Associations representing dentists and eye doctors have long pushed for inclusion of their services in Medicaid. They have doubled their efforts this year, since health reform would expand the number of poor adults covered through this social safety-net.

"We think it would be a tragic mistake if Congress passed health care reform but did nothing to improve the plight of those millions of low-income Americans who qualify for dental care under Medicaid but who can't access care due to severe underfunding of the program," said the American Dental Association in a statement.

Seniors » Some elderly Americans could see their vision and dental benefits cost more or be dropped altogether as a result of these health reform proposals.

These potential cuts would only impact seniors who have bought a Medicare Advantage plan from a private insurer.

Medicare Advantage was created to allow private companies to compete against the government's Medicare program, in the hope that it would reduce costs. It hasn't. Medicare Advantage is propped up with federal subsidies that tend to cost the government more than traditional Medicare. Democrats in the House and Senate want to cut those extra payments.

Private companies have often used that additional money to offer benefits that go beyond traditional Medicare, such as gym memberships, lower premiums or vision and dental.

It is likely that if these cuts are made, some private insurers would either raise premiums for seniors on Medicare Advantage or drop some of these extra benefits.

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