Dental care for kids was supposed to be one of the "essential benefits" included in health plans sold on the Affordable Care Act's online insurance exchange.
As many as 3 million children were predicted to gain dental coverage via HealthCare.gov, according to the American Dental Association, which cheered this and other requirements of the health law as game changers in the fight against tooth decay.
But leeway given states in crafting their dental benefits is sowing confusion and creating coverage gaps, leaving many families without access to dental care, say child advocacy groups.
It's a problem that may not become apparent to families until after January when they bring their child to the dentist, fears Lincoln Nehring, a health policy analyst at Voices for Utah Children.
"They will discover either they didn't purchase dental coverage on the marketplace," he said, "or the coverage that they did buy only covers cleanings and sealants."
Cavities are largely preventable but remain the most common chronic disease of children between the ages of 6 and 11, according to the U.S. Centers for Disease Control and Prevention (CDC).
Dental benefits sold on the federal exchange are either rolled into medical insurance plans or sold separately as stand-alone plans.
The only dental coverage available to Utahns on the exchange are stand-alone plans, which poses a problem on a couple of fronts, said Nehring.
Stand-alone plans don't qualify for subsidies, and there's no state mandate to purchase them.
Nehring suspects many families will think oral care is embedded in their exchange plan and won't bother to take the extra step to purchase dental coverage.
And those who do may be surprised to learn how skimpy the benefits are, assuming they take time to read the fine print, he said.
Most states mandate coverage of restorative work, such as fillings for cavities. In Utah, dental plans on the exchange need only cover cleanings and sealants for children.
By limiting mandates, state lawmakers hoped to keep prices in check and give consumers more choice.
Indeed, Utah dental insurers are offering a diverse and mostly affordable selection of plans on the exchange, said Nehring. Some cover fillings and orthodontics, such as braces.
But the federal system developed to guide consumers in making choices is confusing, Nehring argues. "It's not easy for families to understand what they're buying."
Unlike medical plans that are classified as bronze, silver or gold, dental plans are dubbed as offering "high" or "medium" coverage.
That refers to their actuarial value, though, or how much of the cost of any given procedure the plan pays. It doesn't describe which procedures are covered.
"So we set up a situation where you could have a plan deemed high that costs $15 a month but only covers cleanings and sealants, compared to a medium plan that might cost $25 but includes fillings," said Nehring.
The rules may change. The Obama administration is expected to revisit its "essential benefits" requirements in 2015 for the following year.
Until then, advocates urge families, insurance brokers and navigators to vet dental plans carefully, which requires digging into detailed benefit summaries on each insurer's website.
"Navigators are trained nationally so they're not being educated on the fact that Utah's dental benefit is so thin," said Nehring. "And if the people helping families don't realize this, it's really unlikely families know."
Plan to buy health insurance?
Deadline approaching • Consumers have until Monday to purchase health coverage that takes effect in January. The online insurance exchange HealthCare.gov will stay open for enrollment, however, through March 31.
Need help enrolling? • There are several options for those who need help shopping the Affordable Care Act's online health exchange:
Online chat at healthcare.gov
Toll-free call center at 1-800-318-2596
Go to http://www.takecareutah.org or call 211 to find the nearest trained navigator
Find a certified insurance broker near you at bit.ly/brokerfind.