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Illinois’ new health insurance exchange could provide a pathway to coverage for tens of thousands of previously uninsured Illinoisans, but it is unclear how many of them would end up sitting in a dentist’s chair.
State-based exchanges are mandated under the Affordable Care Act (ACA). They are supposed to open in each state Oct. 1, and this new form of coverage would begin Jan. 1, 2014.
Although the exchanges must meet certain federal criteria, they will vary widely from state to state. For example, while the ACA requires every state to offer children’s dental services, the package of services can vary. In Illinois, the exchange will offer orthodontia but it is likely that this benefit would be strictly controlled. More on this later.
Most significantly, the ACA won’t require exchanges to offer adult dental services. The Illinois exchange could offer adult dental coverage in a “stand-alone” policy, but by the end of 2012 it was not yet clear whether it would do so. And even if it did, consumers would not be obligated to buy it, according to the Illinois State Dental Society (ISDS).
It is also unclear how the Illinois exchange would affect reimbursements. In theory, exchanges are supposed to control healthcare costs by forcing insurers to compete on price, which could lead to a reduction in reimbursements. But many observers don’t think that will happen. Insurers that lower reimbursements risk losing participating providers and ending up with a tiny provider pool.
By using the exchange, Illinoisans will be able to buy a package of standardized benefits from many different participating insurers. While standardizing benefits shuts out services like adult dental coverage, it is essential because consumers will be able to directly compare plans.
The exchange will operate through an official website that will function a lot like Travelocity or Expedia. Instead of booking a flight or a hotel, consumers will choose an insurance carrier and the level of the premium, measured by bronze, silver, gold and platinum levels. Consumers who choose a lower premium level would sustain higher out-of-pocket charges at the point of care. This would be an issue for providers, who collect the out-of-pocket.
Consumers don’t have to buy coverage on the exchange, but they will be lured there by generous federal subsidies available only through the exchanges. The subsidies go to people earning up to 400 percent of the federal poverty level, which in 2011 was $43,560 for an individual or $89,400 for a family of four.
In addition, small businesses meeting certain criteria would be given a 50 percent tax credit if they insured their workers through the exchange. In this way, some Illinois dentistry practices could become customers of the exchanges, but it is not known how many of them would qualify, ISDS said. To qualify, practices would need to have fewer than 25 employees, cover at least 50 percent of workers’ health insurance costs, and the average annual employee wage would have to be under $50,000.
At the end of last year, several key questions still had to be resolved:
The Illinois exchange needs to resolve these questions by spring, according to ISDS. Insurers then work to finalize their proposed offerings, then the exchange has to review and approve those offerings by October, when consumers can start selecting plans.
ISDS reports that the chief reason these issues haven’t been resolved is that final rules have not been issued by HHS, which oversees the exchanges.
Illinois’ failure to pass legislation to administer the program may also hamper progress. Without enabling legislation, the Illinois Department of Insurance must manage the exchange in partnership with HHS for at least the first year. That means HHS has to approve key decisions and there will be less flexibility in design of the exchange.
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A tradition of working for the dental profession. The Chicago Dental Society was organized in 1864 and incorporated in 1878. The objective of the Chicago Dental Society is to encourage the improvement of the health of the public, to promote the art and science of dentistry and to represent the intrest of the members of the profession and the public that it serves.
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