Those of us in dentistry know that a person cannot truly be healthy unless they have good oral health. Dentists often see things in our patients’ mouths that can be precursors to chronic health conditions. Given that, why doesn’t health insurance cover dental health the same way it covers all other aspects of health?
Which brings me to something I’ve been thinking a lot about recently as we’ve seen private insurance reimbursements rates decline. Should Medicare cover dental health? How can the dental profession more effectively advocate for that?
It seems to me that this change is inevitable. It’s not going to happen right away and it will likely be as messy a process as passing the Affordable Care Act (ACA) was. But we might start to think about new ways to approach the issue of dental insurance because the current system is not sustainable.
Many people lack dental insurance, which affects whether they receive care. Two-thirds of working-age adults and only one-third of older adults have dental benefits coverage, according to the American Dental Association. 85 percent of U.S. adults with insurance saw a dentist at least once in 2022, according to the data platform Statista. That's compared to 64 percent of uninsured adults. For children, the numbers for dentist visits are 86 percent with insurance and 72 percent without. How can people stay on top of their health when their dental health needs are not covered?
For many people who do have dental insurance, the benefits are capped at about $1,500 per year. If you’re in a car accident and the airbag hits you in the face, and you need to see a periodontist like me to rebuild your anterior teeth and graft the bone, it will cost $40,000 to $50,000. In a country where only 37 percent of working adults can only cover a $400 expense without borrowing money or using a credit card, that could result in a catastrophic debt load for an individual or family.
Right vs. Privilege
Is health care a right or a privilege? That political debate has been ongoing since the 1940s.
In his State of the Union message to congress in 1944, President Franklin D. Roosevelt presented what he called the “Second Bill of Rights.” One of the things it included was “The right to adequate medical care and the opportunity to achieve and enjoy good health.”
Decades later, the ACA’s passage demonstrated that many people consider health care a right—as evidenced by the millions of formerly uninsured people who snapped up plans when they became available. The numbers of people buying into the ACA marketplace has increased 33% in just the last year.
Research funded by the National Institutes of Health has shown links between oral health and diabetes, heart disease and other illnesses. Dentists are more than caretakers of teeth, we are oral health physicians.
This enhanced role unlocks the potential for tremendous financial benefits in addition to the benefits to patient health, the Centers for Disease Control and Prevention says that “medical-dental integration between oral health and chronic disease prevention programs benefits patients and saves money.” And it points out that the health care system could save up to $100 million a year if dental offices performed screenings for diabetes, high blood pressure and high cholesterol.
One of the most powerful arguments to connect dental insurance to health insurance can be found in studies that have shown a link between missing teeth and mortality.
Selling it to Society
Those of us in the dental profession know the connection. But we have fallen short in our efforts to sell it to society.
People know about diabetes, obesity, cancer, HIV—as they should. The medical profession has done great work in lifting stigmas and encouraging effective communication between doctors and patients. The Internet has also expanded access to information.
Yet for reasons I’m at a loss to explain, the dental profession relies mostly on the same message it has for decades. We encourage people to brush (ideally several times a day) and warn about the dangers of sugar in drinks and so many other processed foods.
Those are important messages, to be sure, but we can also emphasize that the mouth is the gateway to the body. It’s the canary in the coal mine: Dentists have a clear picture of how healthy someone is the moment they look inside their mouth.
Why hasn’t the American public made the connection between oral health and overall health? Why don’t Medicare and other insurers cover dental procedures?
The answer is as painful as a toothache.
It’s our own fault.
Making the Change
Why haven’t dentists made a stronger case?
I have my own theories. I’m not sure most dentists want to be part of a different system or association than what we already have. Perhaps we are afraid we will lose our independence or be relegated to a secondary role in providing care to our patients. Still, change is coming and if we don’t choose our own path, someone else might choose it for us.
We are now seeing the integration of health records and the shift toward integration of care is inevitable. The largest barrier to that may be insurance coverage. If dental insurance remains a separate entity, then so will dental care in the minds of patients who only have health insurance. To best serve our patients, we must consider becoming champions of combining dental insurance with existing health plans.
I’m enough of an optimist to think we can change things. Please join me in advocating that health insurance cover the whole patient, including their mouth.
