National Health Policy Forum Dental Coverage Carrie Banahan July 25 , 2014 Executive Director What is kynect ? An organized marketplace for individuals and employees of small businesses to shop for health insurance offered by insurers (insurance companies, CO-OPs and OPM plans), and compare those plans based on price and quality. Individuals may also apply for Medicaid or the Kentucky Children’s Health Insurance Program (KCHIP) coverage through the Exchange. The Affordable Care Act requires states to create their own exchanges or default to a federal exchange. Kentucky opted to create its own. 2 Dental Health in Kentucky • Kentucky rankings in dental health need to be improved 41st in annual dental visits 47th in percentage of adults 65+ missing six or more teeth (52.1%) 45th in percentage of children with untreated dental decay (34.6%) 3 Pediatric Dental Health Initiatives Kentucky • Initiatives underway to improve dental health of Kentucky’s children, particularly in Appalachia Kentucky Health Now • Goal: Reduce percentage of children with untreated dental decay by 25% and increase adult dental visits by 10% Healthy Smiles Kentucky • Access for Babies and Children to Dentistry (ABCD) training for general dentists on how to care for young patients • Oral health coalitions • Smiling Schools program 4 NASHP Dental Initiatives January 2014- NASHP convened state and federal marketplace officials, dental stakeholders, and national experts. Identified issues related to coverage, benefit design, and affordability; and Discussed concerns with implementation. April 2014- NASHP Issued report “Improving Integration of Dental Health Benefits in Health Insurance Marketplaces”. Described key issues in delivering pediatric and adult dental benefits in the marketplace; Identifies potential policy strategies for future years. 5 kynect Insurer Participation • Individual Plans • Anthem • Kentucky Health Cooperative • HUMANA Individual Catastrophic Bronze Silver Gold Platinum Total Anthem 1 5 4 1 0 11 Co-Op 1 1 1 1 1 5 HUMANA 4 4 4 4 4 20 Anthem 1 1 2 OPM Total 6 10 11 7 5 38 6 kynect 2014 Dental Insurer Participation • Individual Plans • Anthem 2014 • Best Low = 70% • Dental Concern High = 85% Low – High – MOOP $1,000 for one child Low – High – Individual Adult and Adult and Total $2,000 more than 1 Child only Child only Child Child Anthem 1 1 1 1 4 2015 Best 1 2 1 2 6 Dental Concern 0 1 0 1 2 MOOP $350.00/$700.00 Total 2 4 2 4 12 7 kynect Insurer Participation • Small Group Plans • Bluegrass Family Health • Kentucky Health Cooperative • Anthem • United HealthCare Small Group Bronze Silver Gold Platinum Total Anthem 2 2 2 6 Co-Op 1 1 1 3 Bluegrass 2 4 4 2 12 United 1 1 1 3 Total 6 8 8 2 24 8 kynect 2014 Dental Insurer Participation 2014 • Small Group Plans • Anthem Low = 70% High = 85% • Best • Guardian Life MOOP $1,000 for one child $2,000 more than 1 Low – High – Low – High – Small Group Adult and Adult and Total 2015 Child only Child only Child Child Anthem 1 1 1 1 4 MOOP $350.00/$700.00 Best 1 2 1 2 6 Guardian 1 1 1 1 4 Total 3 4 3 4 14 9 Policy Decisions – Mandatory Purchase • kynect Advisory Board • 11 members • 6 subcommittees including Dental/Vision Subcommittee • Dental/Vision Subcommittee Task Force recommendation adopted by kynect Advisory Board • Require households with children up to age 21 to purchase qualified health plans that include pediatric dental essential health benefits • Mandatory purchase provision as adopted by Advisory Board effectuated via administrative regulation • 900 KAR 10:010 http://www.lrc.ky.gov/kar/900/010/010.htm 10 Policy Decisions – kynect Pediatric Dental Essential Health Benefit • Kentucky Benchmark Plan Recommendation Supplement pediatric dental benefits in recommended benchmark plan with pediatric dental benefits available through the Kentucky Children’s Health Insurance Program (KCHIP) 11 Services Covered by kynect Dental Plans • Diagnostic and preventive services - periodic oral exam, teeth cleaning, bitewing x-rays • Basic services – fillings • Endodontic services – root canals • Periodontal services – scaling and root planing • Oral surgery • Major services – crowns • Prosthodontic services – dentures, bridges • Medically necessary orthodontic services 12 kynect Dental Plan Benefits • Rates 1 Child - Anthem Dental Plan $18.28 - Dental concern - $43.50 2 Children - Anthem - $36.56 - Dental Concern - $87.00 • Deductibles Range from $0 to maximum of $100 per person • Out-of-network benefit Offered by all plans with the plan paying a small percentage of costs • Diagnostic and preventive services Plans pay between 100% and 90% for in-network, usually with no waiting period 13 kynect Dental Plan Benefits (cont.) • Basic Services Plans pay between 50% and 80% for in-network; some plans have waiting periods • Endodontic, periodontal, major services, medically necessary orthodontic services Plans pay about 50% in-network; some plans have waiting periods • Annual maximum benefit Usually offered; range from $0 maximum to $1,500 14 2014 Plan Year Enrollment – Dental Plans Insurers Enrollments <21 4932 Anthem Health Plans of KY(Anthem BCBS) 4303 BEST Life and Health Insurance Company ) 335 The Dental Concern, Inc. 294 >=21 10832 Anthem Health Plans of KY(Anthem BCBS) 5038 BEST Life and Health Insurance Company 1234 The Dental Concern, Inc. 4559 The Guardian Life Insurance Company of America 1 Grand Total 15764 15 Consumer Welcome Page 16 About You and Your Household Build Your Household – Household Members Build Your Household – Household Members Your Results Select Coverage 21 Dental Shopping Screen 1 22 Dental Shopping Screen 2 23 Compare Dental Plans 24 25 .