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Covered California and Obamacare 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 Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


CC Pediatric Dental?

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Question: I’ve gotten conflicting answers about this (pediatric dental). Covered CA rep said they were required to offer it but I was not required to buy it. But Anthem won’t let me buy a policy through them without the added PD policy (its not included in the medical policy). Anthem rep says its the state law & that possibly Covered CA has an exemption even though they are offering identical policies. The State Dept of Insurance could not explain why the difference in answers. What gives!?

Answer: Months ago, Covered California decided not to require carriers seeking to participate in the exchange to include pediatric (-19) dental benefits in their medical plans offered through the exchange. So the carriers set their rates without accounting for pediatric dental benefits. Later, the exchange realized they made a mistake and are actually out of compliance with, at least, the ACA’s intent on this issue. Too late, the rates were set. In the meantime, the carriers’ off-exchange plan offerings learn must include pediatric dental. What a paradox, the exchange is not including pediatric dental and out-of-compliance with the law and the non-exchange got it right.

8 Comments

Please stop this partisan bickering. This is not the forum for it. I will not publish another political comment.

Please stop this partisan bickering. This is not the forum for it. I will not publish another political comment.

I am not here to defend Social Security, Medicare, or Medicaid/Medi-Cal. Those “entitlement” programs are bankrupting America. Just take a look at www.usdebtclock.org for an unbiased statement of the reality facing America. If you want socialized medicine, fine, campaign for it. I, for one, do not need the government to take care of me like that.

And I am certainly not any kind of fan of GW Bush and his failed attempt to resurrect Reaganomics. He and his Republican cohort spent money like drunken sailors on liberty. Under Bush’s “leadership” the U.S. debt increased from $5 TRILLION to $9 TRILLION in 8 years.

But Obama and the Democrats have elevated spending to unfathomable heights, nearly doubling the debt from $9 TRILLION to more than $17 TRILLION today, and that’s only take five years. Unless spending is genuinely reigned in, America will destroy itself with entitlement spending alone. Annual defense spending is barely more than the interest on the federal debt and federal pension payments, but Social Security and Medicare/Medicaid spending alone is more than double what we spend on defense — and as you correctly point out, some of that has been spent needlessly over the past 12 years.

America will not run out of money … it will print as much of it as it needs. But that has been tried before in the last 100 years, and has

My suggestion: invest in Kimberly-Clark — they make toilet paper. In a few years, that commodity will be more valuable than the paper money we buy it with.

What crap.

Part D was passed by Bush with absolutely NO FUNDING. This from your conservative compatriots.

Medicare, socialized medicine, works, and works well. Yes, it has needed and needs tweeks to adjust with the times and population.

It certainly is about priorities of allocation of funds. Military budget doubled in 10 years, two years ago. For what…? Priorities?

Social Security is not about to go belly up. That Bush lie continues; in 2042 SS will still payout at about 80% current levels. And it’s a VERY easy fix, just start taxing SS uncapped above $110K in earnings where currently no income is taxed at all (geez, that’s fair).

If you consider all the squeezing and wasted spending legitimate, then yes, you’re right to be concerned about no money available, but this view is for followers, as plenty of money is there and is available should policy and action follow. This no money theory is unrealistic, and is now clearly becoming a tow-the-line excuse of the irresponsible, if not corrupt.

“we need true socialized medicine.”

Really? At whose expense? And with what outcome for society? What model would you pattern such a system after, or what new model would you implement?

We have such an example before us in the form of Medicare, and to a lesser extent, Medicaid/Medi-Cal. What are the results?

The 48-year old Medicare Part A/Part B and the 8-year old Part D plans currently combine to produce a $110,700,000,000,000 unfunded liability. That’s $110.7 TRILLION. The Part D plan alone in its 8-years of existence, was supposed to have cost less than $600 BILLION, but the liability is now more than $22 TRILLION — only 36 times more than expected — and the deficit is growing at faster rate than the combined $105 TRILLION unfunded liability of Social Security and Medicare Parts A and B. So those “socialized medicine” models are no good.

As for Medicaid/Medi-Cal, why is it that California was recently graded “F” when it comes to the number of emergency rooms, at 6.7 per 1,000,0000 of population? Could it be that the reimbursement rates to physicians and other providers, including hospitals, are so pathetically low that they have chosen not to treat the “socially insured”?

And now, if all that isn’t enough, one of the elected knuckleheads in Sacramento, Ricardo Lara, is proposing a “Cal-Obamacare” plan that would make state-provided health insurance available to illegal immigrants. Where exactly will the funding for that come from?

According to Lara, “we won’t have a truly healthy state until everyone has access to quality, affordable coverage”. Free does not equal affordable. Someone has to pay for it. Nothing prevents illegal immigrants from purchasing health insurance — they just cannot get it through the exchange and have the federal government provide tax credits to pay for it.

But what the heck? Let’s just proclaim private health insurance illegal in California, and leave it up to the state to provide everyone within its borders with coverage. Perhaps you’ll be able to take a $25 high-speed rail trip to San Francisco to get to an urgent care center.

Every last ounce of common sense has already left the majority of the elected minds in Sacramento and, apparently, of some commenters here who choose to ignore (or do not understand) the economics of failed social policies.

Unfortunately, socialized medicine cannot heal that affliction.

This is why we need true socialized medicine.

We need to put these parasitic insurance corporations like Anthem out of business once and for all.

Anthem Blue Cross is the only carrier which charges adults additional monthly premium for pediatric dental, a ‘benefit’ adults can never utilize.

Blue Shield, like Anthem, requires selection of a pediatric dental plan along with purchase of a medical plan. Yet for adults mandated to add this pediatric dental plan to their Blue Shield medical plan purchase, Blue Shield does not charge for this added ‘benefit.’ Makes sense since adults can never utilize it.

Some of the Blue Shield plans include Pediatric Dental as required by the PPACA. Additional family dental coverage is optionally available, and would include the pediatric dental benefits.

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