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AAE Supports Administration’s Expansion of Adult Dental Coverage on ACA Marketplace

The AAE submitted comments in support of a new proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would grant states the option to designate adult dental services as an Essential Health Benefit (EHB) for individuals enrolling in insurance on the Affordable Care Act (ACA) exchanges in 2025.

This policy proposal is significant to the dental industry because it aims to bridge a coverage gap by making adult dental services more accessible to individuals enrolled in insurance on the ACA marketplace. Historically, the federal government prohibited adult dental services as an EHB on ACA exchange plans. Recognizing this disparity, the Administration has taken a step forward this year by acknowledging the contrast in dental coverage between the ACA exchanges and the private employer marketplace, where dental benefits are commonly provided.

The proposed rule seeks to rectify this gap by affording states the flexibility to offer adult dental coverage as an essential health benefit, aligning with prevailing practices in the private sector. If adopted, this proposal will help increase access to quality oral health care, especially for low-income and minority communities.

The AAE also urged CMS to conduct routine oversight of insurers, ensuring fair reimbursement to dental providers and prioritizing quality patient care under the proposed rule. The proposal also calls on State-Based Exchanges to implement stringent network adequacy standards like Federally-Facilitated Exchanges – a measure supported by the AAE to better incentivize fair negotiations between insurers and dental providers during the network contracting process.

Furthermore, the AAE commends the Administration for publicly recognizing the crucial link between oral health and overall healthcare, particularly in relation to cardiac disease, stroke, and cancer. The proposed rule aligns with CMS’ Strategic Plan and recent policies designed to expand public access to oral health coverage – thereby enhancing health outcomes.

Public comments on this proposal will be accepted until January 8, 2024, and the AAE remains committed to actively engaging in the rulemaking process, advocating for increased opportunities for dental coverage access. The finalized rule is expected in 2024 and planned to go into effect in 2025.

You can read the AAE letter to CMS here and learn more about the proposed rule on the Agency’s website.