National Health Policy Forum Dental Coverage

Transcription

1 National Health Policy Forum Dental Coverage Carrie Banahan Executive Director July 25, 2014

2 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

3 Dental Health in Kentucky Kentucky rankings in dental health need to be improved 41 st in annual dental visits 47 th in percentage of adults 65+ missing six or more teeth (52.1%) 45 th in percentage of children with untreated dental decay (34.6%) 3

4 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

5 NASHP Dental Initiatives January 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 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

6 kynect Insurer Participation Individual Plans Anthem Kentucky Health Cooperative HUMANA Individual Catastrophic Bronze Silver Gold Platinum Total Anthem Co-Op HUMANA Anthem OPM Total

7 kynect 2014 Dental Insurer Participation Individual Plans Anthem Best Dental Concern 2014 Low = 70% High = 85% Individual Low Child only Low Adult and Child High Child only High Adult and Child Total Anthem Best Dental Concern Total MOOP 2015 $1,000 for one child $2,000 more than 1 MOOP $350.00/$

8 kynect Insurer Participation Small Group Plans Bluegrass Family Health Kentucky Health Cooperative Anthem United HealthCare Small Group Bronze Silver Gold Platinum Total Anthem Co-Op Bluegrass United Total

9 kynect 2014 Dental Insurer Participation Small Group Plans Anthem Best Guardian Life Small Group Low Child only Low Adult and Child High Child only High Adult and Child Total Anthem Best Guardian Total Low = 70% High = 85% MOOP 2015 $1,000 for one child $2,000 more than 1 MOOP $350.00/$

10 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:

11 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

12 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

13 kynect Dental Plan Benefits Rates 1 Child - Anthem Dental Plan $ Dental concern - $ Children - Anthem - $ 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

14 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

15 2014 Plan Year Enrollment Dental Plans Insurers Enrollments < Anthem Health Plans of KY(Anthem BCBS) 4303 BEST Life and Health Insurance Company ) 335 The Dental Concern, Inc. 294 >= Anthem Health Plans of KY(Anthem BCBS) 5038 BEST Life and Health Insurance Company 1234 The Dental Concern, Inc The Guardian Life Insurance Company of America 1 Grand Total

16 Consumer Welcome Page 16

17 About You and Your Household

18 Build Your Household Household Members

19 Build Your Household Household Members

20 Your Results

21 Select Coverage 21

22 Dental Shopping Screen 1 22

23 Dental Shopping Screen 2 23

24 Compare Dental Plans 24

25 25