Insurers selling health policies in the small group and individual market including on exchanges must provide a pediatric dental component. But the extent to which orthodontic services will be covered depends on whether a service is classified as cosmetic or medically necessary, says NADP Executive Director Evelyn Ireland, meaning only about 30% of current orthodontic procedures would be covered under essential health benefits packages. Some plans will add broader orthodontics coverage as a voluntary option, but all of the changes could result in employer cost shifting to employees, Ireland said. Too much cost shifting would likely result in adults dropping dental coverage and in poorer oral health outcomes for adults.
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