===========================================================  ACA DENTAL:

< >  ACA  = Federal Patient Protection & Affordable Care Act  =  ObamaCare Dentistry:    


( )  Mandatory Health Coverage:  Tax penalty of $95 for 1st year, up to $695 in 5 years, for being Uninsured

( )  Open Enrollment starts October 1, 2016 thru March 31, 2017 for January 1, 2017 Insurance Coverage

( )  Dental and Medical Insurance Coverage starts January 1, 2016 nationwide

( )  Pediatric Dental Benefits (under 19 years old) are included as one of the Affordable Care Act’s Essential Health Benefits that will be offered through the California Health Benefit Exchange, and it is estimated that more than one million California children will gain dental coverage

( )  Same provisions as RomneyCare of MA

( )  Open Enrollment to Change Plan from HMO to PPO:   Oct 1, 2016 thru Dec 15, 2016 for January 1, 2017


Dr. Lauren Friedman DDS can "have your Insurance pay the Most, so You pay the Least".  1-310-418-7788


=============================================================  CoveredCA:

< >  Covered California Health Benefit Exchange:     www.CoveredCA.com    


1-888-975-1142     1-800-300-1506     1-800-318-2596     Call Centers     Enrollment Counselors


(Yes)  Real Dental Insurance:  PPO  DPO  DPPO  EPO  DEPO.  Insurer Pays 80% of your Discounted Dental Care.  Dental Preferred Provider Organization.  Dental Exclusive Provider Organization.


(No)  Discount Dental Plans:  HMO  DHMO  DDP.  Insurer Pays 0% of your Dental Care.  You pay 50% of Dentist's Private Fees.  You need Pre-Approval to see a Dentist Specialist, or to see a Dentist Outside of the HMO Network.  You must wait 1 year to change from your HMO to any PPO Plan & only during the Open Enrollment 2 weeks period.  Dental Health Maintenance Organization.  Discount Dental Plans.


( )  Delta Dental of California

Largest Dental Insurer in California

( )  Liberty Dental

 Dental HMO

( )  Premier Access Dental


( )  Anthem Blue Cross Dental


( )  Blue Shield of California

Limited Doctors on their Network

( )  Health Net Dental

Dental HMO


( )  5 Dental Insurers in Covered California Dental Insurance Exchange:  Delta Dental of California.  Blue Shield of California.  Liberty Dental.  Premier Access.  Health Net.

( )  Anthem Blue Cross.  ( )  Guardian.  ( )  MetLife.  ( )  Safeguard. 


( )  Dental Insurers Not in Covered California Dental Insurance Exchange:  Anthem Blue Cross.  Assurant.  Cigna.  "Grandfathered" Dental Insurance Plans.  Employers' Dental Plans


( )  Insurance Premiums:  Stand-alone plan premiums range from less than $10 a month for a DHMO plan in some areas, to about $30 a month for a DPPO


( )  Insurance Benefits:  Covered California dental benefit plans feature standard copayments, deductibles and coinsurance requirements. Unlike Covered California’s health insurance plans, dental plans are not designated by metal levels, but come in two actuarial value options: 85 percent, which features higher premiums but lower average out-of-pocket costs; and a 70-percent value plan, with lower premiums and higher average out-of-pocket costs


( )  Federal Government Premium $ Subsidies:  On a Sliding Scale, will pay for part of your Insurance Premium $ Payments, if you earn less than 4 times the Federal Poverty Level of Income = $45,000/year.

Premium and cost-sharing Credits are available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $18,310 for a family of three in 2009)


( )  13 Medical Insurers in Covered California Insurance Exchange: 

( )  Covered California:  is an Active Purchaser, & has contracted with Dental Insurers

( )  Covered California info:     www.CoveredCA.com/Resources.html     www.CoveredCA.com/Collateral.html     www.healthexchange.ca.gov


Dr. Lauren Friedman DDS is a Member Dentist of the PPO DPPO EPO DEPO Dental Insurers.  1-310-418-7788


===========================================================  ACA Insurers:

< >  ACA Dental Insurers = QHP = Qualified Health Plan:    


< >  Stand-Alone Dental Insurance Plans:     for Any Aged persons

www.CoveredCA.com for California.

www.EHealthInsurance.com for 36 States.     www.GetInsured.com  for NM & _


( )  Delta Dental of California

UCLA Employees.  UCLA Students.  Kaiser Medical HMO Option

( )  Kaiser Medical HMO Members

can add Delta Dental of California

( )  Blue Shield of California


( )  Anthem Blue Cross


( )  Liberty Dental

 Dental HMO

( )  Premier Access


( )  Guardian


( )  MetLife

( )  Safeguard

 Dental HMO


( )  Cobra Dental Insurance:  Keep your Employer's Dental Insurance, & you pay the Insurance Premium monthly

( )  No Pre-Existing Conditions Exclusions: 

( )  No Maximum:  for Medical Insurance.  Dental Policies have a $1,500 Maximum per Calendar Year

( )  MLR = Medical Loss Ratio:  80% of Premiums paid to Insurers must be paid in Benefits.  20% for Administration

( )  Adults Insured:  50% have Private Dental Benefits in 2016.  40% have No Dental Insurance


Dr. Lauren Friedman DDS can help you choose the best Dental Insurers.  OnTheMark@Cheerful.com


===========================================  ACA for Children & Students:

< >  Students under 26 years old & Children under 18 years old:    



Delta Dental PPO


Delta Dental PPO

( )  Pediatric Dental Plans:

Bundled with Medical Health Insurance


( )  PPO = DPPO:    Dental Preferred Provider Organizations

( )  EPO = DEPO:    Dental Exclusive Provider Organizations

( )  HMO = DHMO:  Dental Health Maintenance Organizations

( )  EHB = 10 Essential Health Benefits:  1. Pediatric / Child Oral Dental Health Services up to the age of 19 years old


( )  5 insurance companies will offer plans to families who buy insurance through Covered California in 2014:  Anthem Blue Cross, Blue Shield of California, Delta Dental, Liberty Dental and Premier Access


( )  7 companies will offer plans in Covered California’s Small Business Health Options Program (SHOP):  Blue Shield of California, Delta Dental, Guardian, Liberty Dental, MetLife, Premier Access and Safeguard


( )  Dependent Coverage:  Dependents covered under Parent's Health Insurance up to 26 years old.

( )  Children:  Dental Insurance included in Health Insurance Plan.  10 Essential Health Benefits.

( )  2014:  ACA & Covered California do not require Children to purchase Dental Coverage this 2014 year only.


Dr. Lauren Friedman DDS is near UCLA & is in West Los Angeles near the 405 & 10 Freeways.  www.Dental.ws


==============================================================  Employees:

< >  Employees & Employers:    


( )  ACA & the Federal Fair Labor Standards Act (FLSA):  Affordable Care Act has created the State Insurance Exchange Marketplace as of October 1, 2013 for Insurance starting on January 1, 2014.  www.CoveredCA.com


( )  UCLA Employees

Delta Dental

( )  UCLA Hospital & Medical Center

Anthem Blue Cross

( )  LAUSD School District


( )  HSA = Health Spending Account

$2,500 Max Contribution Pre-Tax per year. Unused $ roll-over to next year

( )  FSA = Flexible Spending Account

$2,500 Max Contribution Pre-Tax per year.  Unused $ are lost


( )  Employers with less than 200 Employees:  are not required to provide Medical Insurance under the ACA.

( )  Employers with less than 25 Employees:  are eligible for Small Business Tax Rebates for purchasing Medical Insurance for their Employees under the ACA.  www.IRS.gov/uac/Small-Business-Health-Care-Tax-Credit-for-Small-Employers

( )  Health Net’s withdrawal from participation in Covered California’s 2014 pediatric dental plans. However, Health Net will participate in the offering of Covered California health plans in the individual and small-group markets for 2014

( )  Require employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employer. Employees may opt out of coverage


Dr. Lauren Friedman DDS is a Member Dentist of the PPO DPPO EPO DEPO Dental Insurers.  1-310-418-7788

You can Pay Dr. Lauren Friedman DDS with your HSA Account or your FSA Account.  www.Dental.ws


===============================================================  Medicare:

< >  Medicare Part B:    


( )  Open Enrollment starts October 1, 2013 thru December 7, 2013 for January 1, 2014 Insurance Coverage

( )  UnitedHealthcare? Concordia?: 

( )  Blue Shield of California:  Medicare Advantage Plan.  1-800-747-0010


Dr. Lauren Friedman DDS is a Member Dentist of the PPO  EPO  Medicare Dental Insurers.  1-310-418-7788


===================================================  Medi-Cal & Denti-Cal:

< >  Medi-Cal = Denti-Cal = CA Medicaid:     www.DentiCal.ca.gov     1-800-456-2387


( )  Children under 19 years old:  35% have Medi-Cal Dental Benefits

( )  CHIP = Child Healthy Families Program:  Children's Health Insurance Program Reauthorization Act (CHIPRA)

( )  Medi-Cal will be Eligible to you if your income is under $15,000 per year

( )  Medi-Cal will continue to be administered by the Department of Health Care Services (DHCS) for 3 Million people

( )  DHCS = Department of Healthcare Services:  1-800-322-6384

( )  HFP = Healthy Families Program:  All 880,000 of you Children are being moved to the Medi-Cal and Denti-Cal Program.  & be administered by the the Managed Risk Medical Insurance Board (MRMIB)

( )  Adult Denti-Cal:  May 2014 California Medi-Cal will be paying for Adult Dental Treatments.  Most Dental Benefits were eliminated for Adults in July 2009.  Only Emergency & Extractions will be paid until May 2014

( )  CA Insureds:  8% have Medi-Cal Dental Benefits in 2012


=============================================================  Tax Credits:

< >  ACA Tax Credits & Penalties:    


( )  Tax Credits:  based on multiples of the FPL = Federal Poverty Level:  see our ObamaCare Medical page


( )  Tax Penalties for not having the Mandatory Health Coverage:  see our ObamaCare Medical page


===================================================================  LAWS:



< > CALIFORNIA LAWS:     www.healthexchange.ca.gov

California was the first state in the nation to enact legislation creating a health benefit exchange under federal health care reform. Enabling legislation can be found here: Chapter 655, Statutes of 2010 (Perez) and Chapter 659, Statutes of 2010 (Alquist)


< > FEDERAL LAWS:     www.Healthcare.gov

( )  ACA = Affordable Care Act = ObamaCare:  March 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act, also known as Health Care Reform or the ACA.  2,000 Pages of Legality.

( )  Children:  ACA requires Children to have Dental Insurance Benefits packaged within your Insurer's Medical Health Benefits Plans.  Require states to maintain current income eligibility levels for children in Medicaid and the Children’s Health Insurance Program (CHIP) until 2019 and extend funding for CHIP through 2015. CHIP benefit package and cost-sharing rules will continue as under current law. Provide states with the option to provide CHIP coverage to children of state employees who are eligible for health benefits if certain conditions are met. Beginning in 2015, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100%. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state Exchanges

• Limit availability of premium credits and cost-sharing subsidies through the Exchanges to U.S. citizens and legal immigrants who meet income limits. Employees who are offered coverage by an employer are not eligible for premium credits unless the employer plan does not have an actuarial value of at least 60% or if the employee share of the premium exceeds 9.5% of income. Legal immigrants who are barred from enrolling in Medicaid during their first five years in the U.S. will be eligible for premium credits

( )  Adults:  No ACA Requirement for Adults to buy Dental Insurance.  Optional Benefit add-on


( )  Health Benefit Exchange Board: 

( )  Supreme Court Decision's Impact on Dental Care:  It is important to note that the ACA does not change the

clinical eligibility criteria for Denti-Cal – meaning that nothing included in the statute restores access to dental care for adults through California’s Medicaid program. However, as the law is implemented and California ushers in what many describe as the “culture of coverage,” the intent is that many adults will take the opportunity to access affordable dental coverage through the individual Health Benefits Exchange (Exchange) and the Small Business Health Options Program, also known as the SHOP Exchange

( )  Individual Mandate: 

(no)  Single-Payer Healthcare Option:  Not approved in the U.S.A.  Private Insurance Companies, Employer-offered Healthcare Insurance, Medicare & Medi-Cal / Medicaid are our only choices.  The Public Option safety net is for the poor and uninsured



<1> www.ACADentist.com

www.ACADoctor.com     www.ObamaCareTeeth.com