D e n t i s t r y a n d t h e A f f o r d a b l e C a r e A c t
Overview at the Federal Level The stated primary goal of the ACA is to increase the amount of people who have health insurance coverage through both the expansion of Medicaid and by establishing marketplaces to facilitate the purchase of coverage in the private sector . Americans who have not enrolled in health coverage by the end of 2014 will be required to pay an “ individual mandate ,” or penalty , equal to 1 percent of their yearly household income or $ 95 per person for the year ($ 47.50 per child under 18 ), whichever is higher . Those with a yearly household income under $ 10,150 will not be subject to the mandate , and individual mandates will continue to increase each year .
ACA does not require small businesses with less than 50 full-time employees to provide health insurance to its employees . Since dental offices are often small , most dentists will not be required to provide health insurance , but small business employers who pay at least 50 percent of the premium for employee health coverage may qualify for a tax credit . These credits will disappear after 2016 .
In order to help pay for the additional cost of the ACA , a number of new taxes and tax code changes were implemented , including several which are relevant to your dental practice :
■ A 2.3 percent medical device excise tax went into effect on January 1 , 2013 . Even though manufacturers , not dentists , are responsible for paying the tax , dentists most likely saw an increased cost in their dental supplies .
■ Flexible spending accounts allow employees to set aside tax-free money for medical expenses . In 2013 , the accounts were limited to a set-aside amount of $ 2,500 a year . The amount will increase annually by a cost-of-living adjustment .
■ Starting in 2013 , a payroll surtax of 0.9 percent was implemented on wage and salary income of over $ 200,000
and $ 250,000 for single and joint filers respectively . The Medicare Hospital Insurance tax increased to 2.35 percent on all earnings about $ 200,000 for single filers and $ 250,000 for joint filers . Self-Employed individuals saw an increase from 2.9 percent to 3.8 percent .
■ In 2013 , a 3.8 percent tax on some investment income was enacted for those with modified adjusted gross incomes that exceed $ 200,000 for single and $ 250,000 for joint filers . Investment incomes include rents , dividends , interest , royalties and capital gains on property sales .
For consumers , plans in the individual and small group markets are prohibited from imposing limitations on pre-existing conditions , excessive waiting periods and copayments or deductibles for certain preventative services . Coverage must be guaranteed issue and renewability , and plans are prohibited from rescinding coverage . However , plans are able to use age , tobacco use , where somebody lives and family composition to calculate premiums . These plans must also offer coverage for dependents up to age 26 .
Essential Health Benefits ( EHB ) plans are minimum packages of benefits to be offered through the marketplaces and in small group and individual plans in the private sector . After January 1 , 2014 , all individual and small group plans offered on the federal marketplace must be certified as a “ qualified health plan ,” with the exception of stand-alone dental plans , and must offer an essential health benefits package . Pediatric dentistry is considered an EHB .
ACA provides for expanding Medicaid to “ newly eligible ” adults , whose income is up to 133 percent of the federal poverty level ($ 15,282 for an individual and $ 31,322 for a family of four ). The federal government will pay all of the cost of covering this additional population initially , and 90 percent of the cost in the long term . If all states opt to expand their Medicaid programs along the lines called for in the ACA , up to 3.2 million more children and 4.5 million adults could have access to dental benefits ; the exact number will depend on how states accept the ACA money and choose to expand their Medicaid program .
Implementation of the ACA in Pennsylvania When assessing the current status of the ACA in Pennsylvania , its impact often depends if a patient is an adult or child . Dental coverage is not a mandated benefit for adults who buy health coverage on their own or as part of a small group . Dental coverage also does not have to be included in their health plans . Dental options vary from state to state , but subsidies for eligible people to buy coverage through the new marketplaces won ’ t pertain to stand-alone dental plans . It ’ s also important to note , however , that people won ’ t be penalized for not having dental coverage .
As for children , the ACA expands dental coverage availability to those 18 and younger . In Pennsylvania , the availability of pediatric dental coverage is mandatory , whether the coverage is part of a general health plan or as a free-standing dental plan . When shopping in the federal health care marketplaces , pediatric dental coverage has to be available , but families don ’ t have to purchase the coverage if it ’ s offered as a separate plan .
Insurers offering adult and children dental plans through the exchange include :
❍ Dominion Dental Services
❍ Delta Dental of PA
❍ Capital BlueCross
❍ Dentegra Insurance Company
❍ BEST Life
❍ Humana Insurance Company
❍ United Concordia Life and Health Insurance Company
Please note that this might not be an all-inclusive list of insurers operating within the exchange .
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