Affordable Care Act

With the Affordable Care Act is in effect, the AAPD is collecting information on the types (embedded or stand-alone) of dental plans in your state, the new children you are seeing as a result of the ACA, your response to participating in the exchange plans and your questions regarding the ACA. AAPD would love to hear about your experiences, your patients’ experiences and everything in between. Please share your stories with us so that we can gather information on how the various-run state exchanges are performing. We hope that gathering this information will help us identify issues that will, in turn, be used to help you and your patients. For additional information, see links below or contact AAPD Dental Insurance Consultant Dr. James Nickman at james.nickman@comcast.net or (773) 938-4760.

Guidance for families purchasing ACA pediatric dental insurance:

• AAPD Consumer Guidance
• ADA ACA Consumer Checklist

ACA analysis of interest to AAPD members:

• PDT article on how ACA will impact pediatric dental practices
• ADA ACA Analysis
  • March 2014 Health Policy Institute Report
  • April 2014 Health Policy Institute Report
  • May 2014 Health Policy Institute Report
  • August 2014 Health Policy Institute Report 1
  • August 2014 Health Policy Institute Report 2
  • February 2015 Health Policy Institute Report
  • Info Graphic: ACA SADP Take-Up Rates by State
  • Info Graphic: Dental Coverage Options in ACA

  AAPD Comments on ACA Regulations and Notices

  • (2016) The AAPD Applauds Treasury’s Proposed Rule on an ACA Dental Premium Tax Credit
    The Treasury Department and IRS released on July 8, 2016 proposed regulations relating to premium tax credits under the Affordable Care Act. This included a rule clarifying the inclusion of subsidies for stand-alone pediatric dental plans, as part of the premium tax credit, for plans purchased in a Health Insurance Exchange.
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  • (2015) AAPD and ADA Urge Transparency for ACA Pediatric Dental Benefits
    The American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) sent a letter to the Center for Consumer Information and Insurance Oversight, urging the Center to require states to make the 2017 essential health benefit benchmark plans more transparent in regards to pediatric dental benefits.
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  • (2013) AAPD and ADA Comment on Federal Regulations for Pediatric Dental Benefits in 2015
    On Dec. 18, 2013, the AAPD and the ADA filed joint comments with CMS concerning their proposed rule on benefit and payment parameters for 2015 as they apply to stand-alone dental plan (SADP) coverage under the Affordable Care Act (ACA). The proposal would reduce the annual limit on cost-sharing for stand-alone dental plans to $300 for one child and $400 for two or more children, in addition to eliminating the actuarial value (AV) requirements.
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  • (2013) AAPD and ADA Comment on Federal Basic Health Program Proposed Regulations
    On Nov. 25, 2013, the AAPD and the ADA filed comments with CMS concerning their proposed rule on Basic Health Programs (BHPs). Such programs are an option for states beginning on Jan. 1, 2015, to cover individuals who do not qualify for Medicaid but whose income does not exceed 200 percent of the federal poverty level. BHPs are required to offer the essential health benefits package under the ACA, including a pediatric dental benefit.
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  • (2012) Essential Health Benefits: AAPD and ADA Comment on Proposed Federal Regulations
    Pediatric oral health is defined under the Patient Protection and Affordable Care Act (ACA) as an essential health benefit. Health insurers in the individual and small group markets, inside or outside of state health insurance exchanges, must offer qualified health plans that cover ten categories of essential health benefits.
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  • (2012) AAPD and ADA Comment to Federal Government on Federally-Facilitated Exchanges Guidance
    On August 3, 2012 the AAPD and ADA submitted comments in response to May 16, 2012 guidance issued by the Center for Consumer Information and Insurance Oversight (CCIIO) regarding federally-facilitated exchanges (FFE).
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  • (2012) AAPD and Organized Dentistry Coalition Urge Repeal of Medical Device Tax
    The AAPD and the Organized Dentistry Coalition, along with over 700 other organizations, sent a letter to the U.S. House of Representatives in June 2012 urging a repeal of the medical device tax contained in the Affordable Care Act.
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  • (2012) Organized Dentistry Coalition Comments on Essential Health Benefits Guidance
    The AAPD, the American Dental Association, and other members of the Organized Dentistry Coalition (ODC) commented to the federal Center for Consumer Information and Insurance Oversight (CCIIO) on Jan. 31, 2012, in response to draft guidance from this agency on essential health benefits (EHB).
    Read More

  Health Insurance Exchange Website:

  • HealthCare.gov is the federally-facilitated or partnership health insurance exchange website for 34 states, and features links to the state-run exchanges for the other 16 states plus the District of Columbia

  Guidance on Essential Health Benefits and State Benchmarks:

  • NHLP Update (March 2015)
  • CMS EHB Summary Page (contains information for each state)

  Essential Health Benefits Implementation Under ACA

  Resources on State Implementation of Affordable Care Act Essential Health Benefits (including pediatric oral health benefit) Under Health Insurance Exchanges

  American Academy of Pediatric Dentistry

  211 East Chicago Avenue, Suite 1600
  Chicago, IL 60611
  (312) 337-2169