ADA Urges CMS to Let Consumers Use Tax Credits for Dental Care Under Select Affordable Care Act Plans

The American Dental Association (ADA) has recently taken a pivotal step by requesting the Centers for Medicare & Medicaid Services (CMS) to permit consumers to use their tax credits for dental care expenses within certain Affordable Care Act (ACA) plans. This development could offer vital relief to millions of Americans seeking affordable dental coverage, a sector that often remains underprioritized in healthcare discussions.

Understanding the ADA’s Proposal to CMS

The ADA’s request emphasizes expanding the applicability of Advanced Premium Tax Credits (APTCs)—federal subsidies designed to lower health insurance costs—to also cover dental care services under specific ACA health insurance plans. Presently, while many ACA plans offer some dental benefits, the tax subsidies mostly apply to medical coverage only, leaving dental care to be paid out-of-pocket or through separate dental plans.

Why is this significant? Because oral health is interconnected with overall health, enabling consumers to use tax credits for dental benefits can improve accessibility, reduce financial barriers, and promote preventive dental visits, ultimately reducing costly emergency dental treatments.

Key Points of the ADA’s Request

• Allow use of APTCs for dental benefits included in ACA medical plans for children and adults.
• Streamline the enrollment process to encourage combined medical and dental coverage in the health insurance marketplaces.
• Encourage insurers to design holistic plans integrating dental and medical care.
• Support CMS in regulatory guidance to clarify how tax credits can be applied toward dental benefits.

Why This Change Could Transform Dental Care Access

Despite the ACA’s broad coverage expansions, dental care remains a challenge for many insured Americans due to cost and limited plan integration. Many consumers must purchase standalone dental insurance policies or pay out-of-pocket for dental services, even when they have medical insurance through the ACA marketplaces.

Benefits of Allowing Tax Credits for Dental Care

• Increase Affordability: Tax credits can significantly lower monthly premiums for plans that include dental benefits, making routine dental care more accessible.
• Comprehensive Coverage: Combined medical and dental coverage helps consumers maintain total health without unexpected dental expenses.
• Improved Preventive Care: Encourages regular dental visits and early treatment, reducing severe dental issues and emergency visits.
• Health Equity: Supports underserved populations who often skip dental care due to cost.

How ACA Dental Coverage Currently Works

The ACA mandates pediatric dental coverage (“essential health benefits” for children aged 18 and under) that must be offered either within medical plans or as standalone dental insurance. However, adult dental coverage is considered an “optional” benefit within the ACA marketplace, resulting in wide variation across states and plans. Furthermore, the tax credits are generally applied to medical coverage only, making mouth health an out-of-pocket expense for most adults.

Practical Tips for Consumers Awaiting Implementation

While the ADA pushes for this change, consumers can still take proactive steps to manage dental care costs:

• Review Your ACA Marketplace Plan Options: Look for plans that include dental benefits, especially those integrated with medical plans for children.
• Dental Savings Plans: Consider dental discount memberships if insurance is cost-prohibitive.
• Utilize Preventive Care: Regular cleanings and exams can prevent more expensive treatments later.
• Ask About Flexible Spending Accounts (FSAs): These can be used for many dental procedures tax-free.

First-Hand Experience: How Dental Tax Credits Could Help Families

Consider Lisa, a mother of two in Ohio, currently insured through an ACA plan without dental coverage. She pays out-of-pocket for cleanings, fillings, and occasional orthodontic checkups for her children. The out-of-pocket costs add up quickly, sometimes forcing her to delay care.

If CMS approves the ADA’s proposal, Lisa could use her tax credits to reduce the financial burden on comprehensive plans with dental benefits, keeping her kids’ smiles healthy and saving money in the long term. Stories like Lisa’s are common and highlight the urgent need for policy reform.

What’s Next? The Policy and Industry Outlook

The ADA’s formal submission to CMS marks an important advocacy milestone. CMS has stated that it welcomes comments on ways to improve individual market coverage, including dental benefits’ integration. Industry stakeholders, dental health professionals, and consumer advocacy groups largely support allowing tax credits to apply to dental care, citing potential long-term public health improvements.

Potential timeline:

• Public Comment Period: CMS may open a comment window inviting other organizations and individuals to weigh in.
• Regulatory Guidance: CMS could issue proposed rules clarifying tax credit use for dental benefits under ACA plans.
• Implementation: Changes could come into effect for the upcoming enrollment period, depending on legislative and administrative approvals.

Conclusion: A Bright Future for Dental Coverage with ADA and CMS Collaboration

The American Dental Association’s push for CMS to allow consumers to use tax credits for dental care under certain Affordable Care Act plans exemplifies a critical shift toward holistic healthcare coverage. This move could make dental insurance more affordable and accessible for millions, improve preventive care, and reduce health disparities.

As CMS reviews the ADA’s proposal, consumers, dental professionals, and policy advocates have a unique opportunity to shape a more inclusive health insurance marketplace—one where dental health is not a luxury but an integrated, accessible priority in America’s healthcare system.

Stay informed, review your options during ACA enrollment periods, and support initiatives that bring dental care within the reach of all Americans.