Effective January 1, 2025, Waiting Periods Will No Longer Be Permitted for the Majority of Adult Dental Services Offered Through the Marketplace
New York State Continues to Explore Improvements to Adult Dental Benefits for 2026 and Beyond
ALBANY, N.Y. (April 4, 2024) – The New York State Department of Health, NY State of Health, and the Department of Financial Services announced today that, effective January 1, 2025, there will no longer be waiting periods for the majority of adult dental services for Individual Stand-Alone Dental Plans available to purchase on the Marketplace. This change is the first of a multi-phased initiative to improve dental products and to improve the dental plan shopping experience for consumers.
The Affordable Care Act includes a long list of codified instructions about what's required under the law. However, like any major piece of legislation, many of the specific details are left up to the agency responsible for implementing the law.
While the PPACA is itself a lengthy document, it would have to be several times longer yet in order to cover every conceivable detail involved in operating the ACA exchanges, Medicaid expansion and so forth. The major provisions of the ACA fall under the Department of Health & Human Services (HHS), and within that, the Centers for Medicare & Medicaid (CMS)
Every year, CMS issues a long, wonky document called the Notice of Benefit & Payment Parameters (NBPP) for the Affordable Care Act. This is basically a list of proposed tweaks to some of the specifics of how the ACA is actually implemented for the following year (actually, it's the year after the following year, since the final rule is generally released in mid-December).
In July, Covered California announced the preliminary weighted average 2024 premium rate changes for the ACA individual market. They still haven't released the final/approved rates, or the small group market average rate changes, but today they released the final rate changes for standalone dental plans:
SACRAMENTO, Calif. — Covered California announced that the statewide weighted average rate change for dental coverage in 2024 will be 4.31 percent. The rate increase is the first since 2020 and continues a trend of holding costs steady for consumers.
The weighted average rate for Covered California’s dental coverage in 2023 will decrease by 1.7 percent, marking the second consecutive year that premiums have gone down for consumers.
More than 294,000 Covered California enrollees have supplemented their health insurance by purchasing optional adult dental coverage, an increase of 28 percent over the previous year.
Eligible consumers can add dental coverage to their plan when they sign up for health insurance during Covered California’s current special-enrollment period, or during open enrollment, which will start this fall.
I don't write about standalone dental insurance plan coverage very often (and honestly, neither does HealthCare.Gov or the state-based ACA exchanges), but it's obviously pretty important.
I don't write about dental plan coverage very often; the only time I've ever really talked about it at length was my angry rant at the HHS Dept. on November 20, 2014 after it was discovered that someone at HHS/CMS screwed up royally by mistakenly lumping in several hundred thousand standalone dental plan enrollments with the full Qualified Health Plan enrollments, falsely making it look like the effectuated enrollment was around 7.3 million people as of August when in fact the number had fallen below the 7.0 million mark.
Otherwise, I don't really talk about dental plans much. There's actually two ways people can sign up for dental plans via the ACA exchanges: Either as "enhanced" QHPs (ie, full healthcare policies which also bundle dental coverage with them...which all of them really should IMHO, seeing how your teeth and gums are part of your body, after all), or as separate, standalone plans which are optional (that is, you don't have to have dental coverage in order to meet the ACA's Individual Mandate requirement).
