Covered California and ACA related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Penalty for Not Taking Pediatric Dental?

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Question: Is there a tax penalty for opting out of pediatric dental? We have one 2 year old and a baby on the way. We bought the whole family insurance on the exchange but it did not come with pediatric dental. The add-on PPO dental plans are very expensive for what they include and our beloved dentist does not take any HMO plans (which are the cheaper options). It seems it would be far less expensive for us to pay for dental check ups out of pocket than to buy the insurance… at least for the next few years while the kids are very young.

Answer: Insurance works best and rates are lower for all, if everyone is in the pool. That’s the reason behind making pediatric dental mandatory. There is no penalty for not taking it, but you will not be able to get medical coverage without it if you have a child under 19.


Gordon, you pay for maternity benefits too. I bet you’ll never delivery a baby either. And you have been paying for these ‘I’ll-never-use-them benefits’ for years under your prior health insurance (if you had coverage).

I agree Anthem should not charge adults to add-in Pediatric Dental at this point. After all, they priced their medical plans without it! Priced without it per negotiations with Covered California.

Anthem is correct to follow the ACA mandate to include such pediatric dental benefits within and as part of the ACA-required Minimum Essential Benefit ‘package,’ yet to charge adults for the pediatric dental benefit when the medical plans for 2014 have all previously been priced without pediatric dental built in?, that’s gouging.

I was just told by Anthem Blue Cross that even though my spouse and I don’t have children starting april 1st we have to pay a premium for pediatric dental coverage and we CANNOT opt out of such coverage.

Why do we have to pay for pediatric dental coverage when we don’ have children? Is this a oversight that will be corrected?

Pediatric dental is optional through Covered California. The Covered California literature and agent training say so too. Business before kids was the decision. Medical coverage is thereby available without pediatric dental… through Covered California only. An irony, for sure.

I don’t think there is any enforcement mechanism in Covered California to ensure Pediatric Dental insurance is purchased. It is not included in any of the plans offered through the exchange. They are currently decoupled and it is left up to the consumer.

Please see the New York Times article on this very topic.

Covered California is planning on addressing and resolving this issue only in 2015.

I am confused. I already applied for coverage on the exchange with the help of an insurance broker. They did not say that I had no choice. I am paying twice what I was playing for insurance before. It is worse coverage and my current insurance is being canceled so I have no choice. Will my application be denied if I do not opt in to a pediatric plan for our 2 year old and infant (who will have no teeth for the first year)?

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