<p>DStark, for you to be charged for coverage that you can’t use seems to be an Anthem thing. Here’s what Blue Shield says:
</p>
<p>You might want to double check on the math to see whether you are in fact being charged for the plan you can’t use. The way I read the Blue Shield info - they are saying that everyone has to choose a plan, but only people with kids will have to pay, for plans bought via their web site. I purchased via Covered California and wasn’t required to select a dental plan.</p>
<p>Are you saying that everyone on the exchange has to select a pediatric dental plan, but if you’re a single 57-year-old your premium for that plan is $0?</p>
<p>Another article labeled “Study” that states the obvious. What do you have to “study” to discover that people might owe taxes at the end of the year if they got advance tax credits they turned out not to be eligible for? Why is this a “study” and not just an explanation? Are we going to get another “study” that tells us if our withholding is too low, we’ll owe taxes at tax time? </p>
<p>Yes, Tatin, there IS a clawback for subsidies for people who buy insurance on the exchanges – but if they are instead enrolled in Medicaid, no clawback. The “subsidies” are actually an advance payment of a tax credit that is reconciled annually with the IRS. Medicaid is not a tax benefit, so when a person is on Medicaid, IRS has no further role. </p>
<p>Obviously if a person’s income increases so that they are no longer eligible for Medicaid, they should report the change and apply for coverage on the exchange, but they won’t have to pay back anything by virtue of having been on Medicaid while their income was low enough.</p>
<p>We didn’t have an option to choose pediatric dental. We did have a chance to answer if we wanted the dental option. In our case, we are already covered by another dental policy (better coverage for better price.)</p>
<p>And calmom covered the income reconciliation issue much earlier in this thread. But this latest link is dated September- a point which I still consider “dark ages” in terms of what people knew.</p>
<p>CF – no, on the EXCHANGE I did NOT have to select a dental plan.</p>
<p>Blue Shield is saying that if you buy a policy DIRECTLY from them (off exchange), then you will have to SELECT a plan, but not be charged for it.</p>
<p>I believe DStark purchased a plan directly from Anthem, off-exchange. Apparently Anthem required him to both select a pediatric dental plan AND pay for it – though I am not sure if he has actually done the math to verify that his monthly premium is increased by that amount.</p>
<p>The plan I signed up for I could have purchased on or off exchange. It was the same price.</p>
<p>I dont know if I would have had to sign up for a dental plan if I purchased the plan on exchange. I dont know why not since the plans on and off exchange are identical.</p>
<p>So…I had to pay an addition $23.xx for a dental plan that I did not sign up for and does not benefit my family.</p>
<p>It looks like Blue Shield includes the pricing for the dental plan in their health insurance plan price.</p>
<p>So I paid 1371.xx for a health insurance plan and an additional 23.xx for the dental mandate.</p>
<p>Here is the difference I noticed between Anthem’s plans on the exchange and the ones through our broker:</p>
<p>On the exchange, office visits (not including preventative care) are just part of the deductible. It’s not just a copay. Through the broker, three office visits per person (six max per family) cost $35 each - more visits than that are part of the deductible. Currently, ALL of my family’s office visits have a $30 copay. So starting February 1, we will be paying a higher premium and getting less. That’s what has been happening for years (paying more and getting less), and it doesn’t look as if it’s changing now. Sure, the OOP maximum is lowered, but it is a rare year that we will reach $6,350/person, anyway.</p>
<p>I don’t know why Anthem would be charging DStark for the pediatric dental. I am certain that the premium amount I am being charged by Blue Shield does NOT include pediatric dental. I did not select a dental plan on the exchange nor did Blue Shield ask me to choose a dental plan for the equivalent, direct policy that they were prepared to roll me over to. (They completed the rollover ahead of the time that I notified them that I was going with the Covered Cal policy instead, so I actually have documentation from BS about premiums). </p>
<p>Pediatric dental is an essential benefit that is required, but ACA leaves it up to the states to decide how to implement that requirement. It makes no sense that coverage that does not include a child would need to have it - so I really don’t understand what Anthem is doing if in fact DStark is “required” to buy and pay for a dental plan. Perhaps DStark might want get the phone number for the Anthem director of sales from GP and ask.</p>
<p>If I go to the Kaiser site to shop for a plan and enter in information for a single adult my age only, then I am presented with an array of choices that say, “MONTHLY DENTAL PREMIUM
N/A”. Kaiser provides the following info about pediatric dental:</p>
<p>"If you purchase the Kaiser Permanente health plans from Covered California:</p>
<p>Dental benefits are not included with the plans.
You may buy Pediatric dental coverage separately though Covered California.</p>
<p>If you purchase the Kaiser Permanente plans outside of Covered California:
The pediatric dental benefits for those ages up to age 19 are included."</p>
<p>Please note the source: I have not confirmed whether or not Anthem is correct in its statement of California law. The notion of a medical plan having pediatric dental “embedded” is consistent with the Kaiser statement above.</p>
<p>I don’t know the pediatric dental coverage works. But it could be that all subscribers are required to pay for pediatric dental coverage, just as I’m required to pay for prostate cancer coverage and dstark is required to pay for maternity benefits, even though we could not possibly use those things. But since regular old insurance companies often don’t handle pediatric dental coverage-- they don’t have dentist networks and so forth-- you have to buy that part of the coverage from a different insurance company.</p>
<p>That’s what I figured by I didn’t get how it would work with Kaiser. Like, are they going to send my kid a Delta Dental card or something. Guess we’ll find out.</p>
<p>Here’s what I read about pediatric dental plans: “The Affordable Care Act requires offering dental care for kids. But families won’t be required to buy the dental plans”</p>
<p>Seems like another glitch, from what everyone is saying, or that the insurance company is confused (big surprise). With the massive hold times, perhaps it would be worth waiting awhile to follow up on that and get a refund later.</p>
LOL</p>