title: The Affordable Care Act and health insurance exchanges: effects on the pediatric dental benefit.
abstract: OBJECTIVE
  To examine the relationship between state health insurance Exchange selection and pediatric dental benefit design, regulation and cost.
  
  
  METHODS
  Medical and dental plans were analyzed across three types of state health insurance Exchanges: State-based (SB), State-partnered (SP), and Federally-facilitated (FF). Cost-analysis was completed for 10,427 insurance plans, and health policy expert interviews were conducted. One-way ANOVA compared the cost-sharing structure of stand-alone dental plans (SADP). T-test statistics compared differences in average total monthly pediatric premium costs.
  
  
  RESULTS
  No causal relationships were identified between Exchange selection and the pediatric dental benefit's design, regulation or cost. Pediatric medical and dental coverage offered through the embedded plan design exhibited comparable average total monthly premium costs to aggregate cost estimates for the separately purchased SADP and traditional medical plan (P=0.11). Plan designs and regulatory policies demonstrated greater correlation between the SP and FF Exchanges, as compared to the SB Exchange.
  
  
  CONCLUSIONS
  Parameters defining the pediatric dental benefit are complex and vary across states. Each state Exchange was subject to barriers in improving the quality of the pediatric dental benefit due to a lack of defined, standardized policy parameters and further legislative maturation is required.
authors: Private practice, Tulsa, Okla., USA. ashleyorynich@gmail.com.
authors: C Ashley
authors: CA
authors: Orynich
authors: Division of Pediatric Dentistry and Community Oral Health, College of Dentistry, The Ohio State University, Columbus, Ohio, USA.
authors: Paul S
authors: PS
authors: Casamassimo
authors: Department of Pediatric Dentistry, Texas A&M Baylor College of Dentistry, Dallas, Texas, USA.
authors: N Sue
authors: NS
authors: Seale
authors: Private practice, Huntington Beach, Calif., USA.
authors: Paul
authors: P
authors: Reggiardo
authors: American Academy of Pediatric Dentistry, Chicago, Ill. USA.
authors: C Scott
authors: CS
authors: Litch
mesh_terms: D002648:Child; D017047:Cost Sharing; D003365:Costs and Cost Analysis; D019140:Dental Care for Children / Q000191:economics; D018166:Health Care Reform / Q000191:economics; D062265:Health Insurance Exchanges / Q000191:economics / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D007347:Insurance, Dental / Q000191:economics; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000458:organization & administration; D014481:United States