Obamacare and dental coverage – what’s included?

It is interesting to note if the Obamacare would cover dental and vision for children and adults up to 26 years. Regrettably the ACA would only cover dental coverage for children under 18 in 2014 through the Qualified Health Plan programs using the Exchange.

There is no definite decision on extending the dental coverage beyond 18 years old although there may be a stand-alone dental plan for those under 65.

HIPAA plan

Consumers are also concerned about their switchover to new QHPs by the Exchange if they are in existing HIPAA plans from 2014. Although the HIPAA plans are likely to be phased out after ACA becomes effective from 2014, consumers under HIPAA can purchase QHPs from the Exchange or outside through private markets at a lower cost with better coverage.

Becoming an Exchange Navigator

There may be interested individuals who wish to be qualified California Exchange Navigators. The following general guidelines apply.

Aspiring Exchange navigators need an affiliation with an Exchange registered enrollment entity which includes County Social Services and non-profit organizations. These must not be enrolling individuals for Exchange products. Exchange navigators cannot be health plan agents, hospitals and community medical clinics.


The California Health Benefit Exchange would accept those in a CA PCIP program for any of its qualified health plans. When January 2014 comes, the PCIP preexisting conditions would not be a consideration with better QHP coverage and rates. Hence, there is no worry about a 6 month waiting period.

The ACA has no mention of a waiting period with the California Exchange most unlikely to implement one or insists on pre-existing conditions in or outside the Exchange.


The California Exchange Board has yet to decide on Accountable Care Organizations’ role and the affordability in QHPs to meet increasing demand of healthcare coverage which is often through innovative benefit plans, designs and efficient provider networks as well as delivery systems.

ACOs have good value-based health plan designs that are affordable and of quality which the Exchange should consider in supporting.

Adequate Assister Training

Many are concerned over the short two-day training for Assisters to be qualified in health plan selections. It is up to the Exchange to implement competency measures and standards of Assisters on their health plan offering.

This is where the California Exchange needs to collaborate with health insurers partners for adequate Assister training. There should be an initial and continuous training for all Assisters of the Exchange.

Leave a Reply