Keeping up With Medical and Dental Markets

Federal law mandates that citizens be covered by medical insurance. Dental coverage is not mandated for anyone. As of November 15, 2014, all citizens may enroll in affordable health care plans through the government’s Health Insurance Marketplace. Anyone who is already covered by health care insurance may or may not choose to change their plans. The Health Insurance Marketplace serves as the network for providing individuals, families and small businesses with information and access to health insurance plans. States differ on how they administer the programs. To determine what each state requires, check with HealthCare.gov. In Oregon, we discussed this topic with several proffessionals to get their take on the new insurance laws.

Marketplace, a division of HealthCare.gov, includes all the private health insurance plans offered in the Marketplace. All plans must include: ambulatory patient services, emergency services, hospitalization (including surgery), pregnancy, maternity and newborn care, mental health and substance disorder services, prescriptions drugs, laboratory services, preventative and wellness services, and pediatric services. Some plans may also offer: birth control benefits, breastfeeding benefits, and dental coverage.

The Health Insurance Marketplace provides health plans for people who are currently uninsured. To determine eligibility and available, services healthcare consumers need to fill out the Marketplace application. Private health insurance plans based on income provide plans including basic health care services. Essential services, pre-existing conditions, and preventive care is available on most plans. Open enrollment begins on November 15, 2014. Anyone can enroll in the Marketplace prior to November 15 if they qualify for a Special Enrollment Period. Anyone may apply for Medicaid or CHIP (Children’s Health Insurance Program) at any time. Anyone not covered in 2015 is subject to a penalty. Some people are eligible for a exemption from the penalty based on income. Healthcare plans purchased through the Marketplace are eligible for tax credits.

Dental insurance is not required by federal mandate for anyone, even for children. If covering a child (anyone under the age of 18), dental plans must be an option of any plan offered by insurers. Insurers must offer dental plans, but consumers are not required to purchase dental insurance. There are two ways to obtain dental insurance: with the health plan or as a stand-alone plan. Dental plans may be added to a health care plan only during open enrollment. When coverage is part of health care plans, premiums are included in the overall cost. Separate, stand-alone dental plans are available to anyone who wants a different type of plan than those offered by a health care plan.