Friday, November 1, 2013

Obamacare's Pediatric Dental Requirement--A Trap for the Unwary

Well, we did it, we successfully filed an application with Blue Cross Blue Shield of Michigan for my wife's health insurance for 2014.  She was among approximately 140,000 BCBSM members who had their individual policies canceled in Michigan.

No, we were not able to order the insurance through healthcare.gov.  We bypassed the government's dysfunctional site and ordered directly from the insurance company.  BCBSM's website seems to work really well, basically how healthcare.gov was supposed to work.

The downside of this approach is that it's not clear whether a policy purchased directly from the insurance company is eligible for tax credits to help pay for it.  In other words, if you buy direct you're probably going to pay full-price.

Our income, like many small businesspeople, is extremely hard to predict.  We have no way of knowing whether our income will fall within the tax credit range.  However, given our situation, we are not in a position to risk having her go without coverage for even a short time.  As badly as healthcare.gov has functioned so far, it's not clear that if it does start working the insurance companies will be able to process a flood of applications in late November and December.  So for us, the best choice was to get a policy in place now.


At the end of the application, we encountered an odd warning.


"Under the health care reform law, every health insurance plan must cover pediatric dental care.  If you select the Blue Dental PPO Personal Pediatric plan, you will only be charged for children under 19 on your contract and only your children will have dental benefits.  If you do not have children under the age of 19, you can still meet the pediatric dental benefit requirement at no additional cost by selecting this plan."

Let's translate that to English.  PPACA, aka Obamcare, mandates 10 categories of coverage every health insurance policy must have (Essential Health Benefits).  If a policy lacks one of these coverages, it's not legal unless some exemption or exception applies.  From the standpoint of the individual, if a policy lacks the coverage, a person could buy the policy AND still owe the individual mandate penalty.  In other words, a person could buy an insurance policy but still be liable for the penalty because the policy was "not good enough" by the government's standards.

One "essential benefit" getting some attention lately is the requirement for every policy to have maternity coverage.  Therefore, men must have coverage in case they get pregnant.  In addition, women beyond child bearing age also have to buy maternity coverage.  Mandatory but useless coverage, of course, makes the policy more expensive.  In another irony, low cost Obamacare-apprroved catastrophic coverage available to Americans under the age of 30 does not have to have maternity coverage.  So a 60 year old man must have maternity coverage, but a 25 year old woman does not.  Oh well, call me sexist.

Back to pediatric dental coverage.  Pediatric dental coverage is also mandatory under Obamacare.  Arguably, having health insurance without it could subject a person to the individual mandate penalty, even if the person has no kids.  To avoid this trap, at least with BCBSM you have to make sure you add a pediatric dental policy to the health policy.  It doesn't cost anything if you don't have kids, but could potentially cause problems down the road if you don't have it.

You don't want to buy an expensive health insurance policy just to find out you're getting fined anyway.

Let's check out some of Today's Obamacare Headlines.

Rightwing Rants

Legal challenges could shut down the exchanges.

Obama's 2009 promises come back to haunt him.

Does anyone still listen to Obama on healthcare?

Why grandfathered plans are going extinct.


Leftwing Cheerleading/Apologetics

Republicans don't want to fix Obamacare.

Medicaid enrollment surges and we love it.

Hard News

How Obamacare could raise your premiums at work.

Healthcare.gov tests indicated it would not work.

Few believe PPACA has helped their health insurance situation.

Lawmakers scramble to push aides into Obamacare exchanges (or not).

Bye bye glitch girl.

For Industry Insiders


Challenges to subsidies finds its way through the courts.

HHS eases deadline conflicts.

Insiders not surprised by plan cancellations.