By the end of 2021, approximately 255 million Americans had some form of dental insurance. Still, a disturbingly high rate of the population remains uninsured.A survey conducted by CareQuest Institute for Oral Health revealed that around76.5 million US children and adults had no form of dental coverage as of that fiscal year.
“Most people are unaware that their oral health is linked directly to their general health,” said American Dental Association spokesperson, Dr. Julius Manz. “Your oral health could show initial indicators to serious and preventable conditions such as strokes, chronic heart disease, or other systemic health issues. This is why visiting your dentist is essential to your everyday well-being.”
According to the Academy of General Dentistry, more than 90% of all systemic diseases produce oral signs and symptoms at some point.
Fortunately, a rising number of American children are getting the dental care they need. The American Dental Association has seen significant changes in dental care utilization patterns since 2000 among the US population. The US Centers for Disease and Control Prevention has documented a rising trend in dental care utilization among children, particularly in lower income groups, over the past decade. The elderly population has also been getting more dental care in recent years.
To put it into perspective, in 2004, the American Dental Association reported that 17% of children were uninsured. That year, 33.3% of children three to five years of age experienced cavities in their primary teeth. By 2016, the rate of uninsured children had dropped to 10% and 29% of children ages three to five had cavities in the previous year.
MEPS 2000—2016 Insurance Breakdown, Children Ages 2-18
The American Dental Association’s Health Policy Institute gathered new data, showing a slight decrease in uninsured children for 2016. – Courtesy of the American Dental Association and the Medical Expenditure Panel Survey (MEPS).
“The American Dental Association and other organizations have worked diligently to address a problem that affects millions of Americans across the socio-economic spectrum,'' said Dr. David Kerr, 2020 President Elect of College of Dental Surgeons of Puerto Rico. “Over the last 36 years of my profession, I’ve seen an incredible decrease amongst patients that need full dentures.”
Kerr believes this improvement is in part due to an increase of educational programs, commercials, and volunteerism efforts targeted to the vulnerable groups that were prone to experience poor oral health or lack of access to regular dental care. This group includes low-income children (ages 0-18), seniors in long-term care, racial/ethnic minorities, and people with special needs.
However, in the US, working age adults still presented the highest percentage of untreated dental cavities at a whopping 31.6% compared to 18.6% of children in 2016.
“According to the CDC, dental visits for both children and seniors are higher than working age adults. This is hard to fathom since this is the group with the most dental coverage through employer group benefits,” said Evelyn Ireland. “This is the group that is targeted for education on getting and using their dental benefits.”
So, what’s the problem?
“It’s plain and simple,” said Dr. Kerr. “A lot of people fear going to the dentist or find it too expensive. Then, they end up in an Emergency Room when the pain is intolerable. Chances are they will be treated for the symptom with pain medication, but their illness--for example, an infection--will go unaddressed.”
People without dental benefits also reported much higher incidences of other chronic illnesses than people who had coverage, according to the ADA.
You might think: “This doesn’t apply to me. If I brush my teeth every day, chances are that I won’t get any serious disease.” Well, according to the American Dental Association and leading experts, you’re wrong.
Preventive dental care is critical to maintaining your overall health. Dr. Manz and Dr. Kerrexpressed that aside from visiting your dentist regularly, flossing your teeth correctly is a straightforward method to maintain oral health. If you’re not sure how to floss,follow these helpful steps created by the American Dental Association.
HOW DOES DENTAL INSURANCE WORK?
Dental insurance operates on a system of coverage and benefits that help individuals manage the costs of dental care. When you have dental insurance, you typically pay a monthly premium to the insurance company. In return, the insurance company provides coverage for a variety of dental services and procedures. When you receive dental treatment, you usually pay a portion of the cost through deductibles, co-pays, or coinsurance, while the insurance company covers the remaining balance up to certain limits or maximums.
WHAT DOES DENTAL INSURANCE COVER?
Dental insurance coverage varies depending on the specific plan and provider. Commonly covered services include preventive care, such as routine cleanings, exams, and x-rays, which are important for early detection and prevention of dental issues. Insurance often covers basic procedures, like fillings and simple extractions.
Thebest full-coverage dental insurance may also provide coverage for major services, including root canals, crowns, bridges, and dentures. However, coverage levels and limitations can differ among insurance plans.
Some plans may have waiting periods for certain services, annual maximums that cap the coverage amount, and restrictions on specific treatments. Reviewing the details of the dental insurance policy and consulting with the insurance provider can provide a clear understanding of the coverage provided.
HOW MUCH IS DENTAL INSURANCE?
The cost of dental insurance can vary depending on several factors, including the insurance provider, the specific plan chosen, geographical location, and individual circ*mstances. You typically pay dental insurance premiums on a monthly or annual basis. On average, thebest dental insurance plans can range from $15 to $50 per month, while family plans can range from $50 to $150 per month.
It's important to note that these figures are approximate and can vary significantly. Additionally, certain factors, such as deductibles, copays, and coinsurance, can affect the overall cost of dental care. To determine the exact cost of dental insurance, individuals can request quotes from different dental insurance companies and compare the coverage and prices to find the most suitable option for their needs and budget.
HOW TO GET DENTAL INSURANCE
There are several ways to acquire dental insurance coverage. One common method is through an employer-sponsored group dental insurance plan. Many employers offer dental insurance as part of their employee benefits package, allowing individuals to enroll during specified enrollment periods.
Another option is to purchase individual or family dental insurance directly from insurance providers. Individuals can explore various dental insurance companies and plans, compare the coverage, premiums, and terms and select the plan that best suits their needs. Some government programs, such as Medicaid and the Children's Health Insurance Program (CHIP), offer dental coverage for eligible individuals and families. Exploring these programs and their eligibility requirements can help you determine if you qualify for their dental insurance.
Word of Mouth: What to Do in an Emergency
TheAmerican Dental Association estimates that about two million people visit emergency rooms in the U.S. for dental-related issues. That's an average of one person walking into an emergency room every 15 seconds.Even though Medicaid expansion under the Affordable Care Act led to an increase in dental coverage and care amongMedicaid-enrolled adults, an estimated$1.7 billionisspentonunnecessary hospital visitseach year.
According to the ADA, the majority of these patients suffered from dental decay that could have been easily prevented with a visit to their dentist. What they soon find out to their dismay is that hospitals aren’t equipped to provide comprehensive dental care.
To get a sense of the bigger picture, at least 50% of the adult population has some form of periodontal disease, according to the Centers for Disease Control and Prevention. Periodontitis, a disease of the gums may cause tender, swollen gums that bleed, painful chewing, and tooth loss or movement.
“What happens generally is that a patient will receive pain medication to treat a symptom, but the underlying illness will go unaddressed,” said Dr. Kerr. “At the end of the day, you’ll still have to go to a dentist to treat the infection or injury and end up spending double the money.”
Trauma cases such as mountain bike accidents that may damage your teeth will often be attended by maxillofacial surgeons or other specialists, depending on the case.
“There are two cases that warrant a visit to the Emergency Room, trauma and cellulitis,” said Dr. Alvin Lugo, a general dentist based in Puerto Rico. “For trauma cases, the ER will stabilize your injuries and have a surgeon attend you. You will then be referred to a dentist or an orthodontist to continue treatment as many hospitals generally are not equipped with these kinds of physicians.”
Cellulitis, Dr. Lugo said, erupts in cases of severe infection and can cause swelling, fever, and pain that can make it hard to swallow. The ER will stabilize the infection, and will refer you to a dentist or specialist depending on your case.
“Dental schools are an affordable alternative if you need low-cost treatment or urgent care,” said Dr. Lugo. “As teaching facilities, they usually have clinics where dental students have the opportunity to gain experience by treating patients under the supervision of licensed dentists.”
Post-graduate and faculty clinics are also available at most schools for more complex procedures, according to Dr. Lugo. In some cases, trauma patients are taken directly to dental school clinics from the ER.
Can Fluoride Prevent Cavities?
Backed by more than 70 years of scientific research, the American Dental Association has confirmed that fluoride in water is safe and effective at reducing tooth decay by at least 25% in children and adults.
The ADA recommends that children under three years old use no more than a grain-of-rice sized amount of fluoride toothpaste. For children three to six years old, use only a pea-sized amount. A list of approved products that contain healthy levels of fluoride and have been approved by the ADAmay be viewed here.
Is Your Smile Healthy? Take the Quiz to Find Out!
Room for Improvement in Providing Dental Insurance to All
Comprehensive coverage of dental care for children under Medicaid and the Children’s Health Insurance Program (CHIP) is one of the 10 essential health benefits (EHB) under the Affordable Care Act (ACA).
Medicaid provides a comprehensive mandatory benefit package for children which includes oral health screenings, diagnosis, and treatment services. However, it’s not available to adults.
Dental benefits for adults on Medicaid are not required by federal law, but are offered as a state option, which has made access to dental coverage more challenging for seniors than for children. Furthermore, most states only provide limited coverage (restricted to extractions or emergency services).
“Seniors are the biggest focus ofthe uninsured population,” said Evelyn Ireland. “Sixty percent of seniors with Medicare Advantage plans instead of traditional Medicare have dental benefits through those plans. In 2017, only 1/3 ofMedicare-eligible individuals had Medicare Advantage plans, and 63% of those have dental.”
In the last decade, Medicaid and Children’s Health Insurance Program (CHIP) have slightly improved their dental care benefits. This improvement has sparked an increase in children’s use of preventive and primary dental services.
“While discussions are underway about adding dental to Medicare, that is a long road politically, so NADP is working to get the Centers for Medicare & Medicaid Services to decouple dental and medical purchases on the federal exchange,” said Ireland. “This would make more affordable individual dental coverage widely available for seniors.”
Types of Dental Insurance Plans
Dental insurance typically comes in the form of three different plan options: dental health maintenance organization (DHMO), preferred provider organization (PPO), or an indemnity plan.
- Preferred Provider Organization (PPO): Dental PPO plans offer you the freedom to visit any licensed dentist, although in-network providers will cost you less. In the long-run, these plans can cost more than a DHMO plan due to higher premiums, but you’re offered more comprehensive dental care.
- Dental Health Maintenance Organization (DHMO): A DHMO tends to be a lower-cost benefits and insurance plan. You are required to choose one in-network dentist or dental facility as your primary care provider. A typical DHMO plan doesn’t have any deductibles or maximums and you just pay a fixed dollar amount (copay) for any covered treatment. If the procedure is not covered by a copay, you are responsible for the total cost.
- Indemnity or Fee-for service dental plans: Also known as a fee-for-service option, these plans offer greater variety because you can pick any dentist. Like PPO plans, you typically pay a deductible, then a fixed percentage for each service, and the plan pays for the rest. However, participating PPO providers usually offer discounts on procedures not covered by your plan. You do not have this option with an indemnity plan, so it’s possible you’ll end up paying more in addition to the high premiums.
- Dental Savings: Also known as discount plans, these plans are not licensed as traditional dental insurance. Their programs provide a network of dental care providers that have agreed to perform procedures at a reduced price. Dentists are paid the discounted price directly by the plan owner, and the dental savings plan will cover the rest of the expense. Dental savings plans aren’t available in every state and can be only used with in-network providers. One benefit of dental savings plans is that they can be used alongside your traditional dental insurance.
