Rethinking dental insurance

An interesting article titled “Time to rethink dental “insurance”” written by Marko Vujicic appears in the Nov. 2017 issue of JADA (vol. 147 issue 12, pp. 907–910). The article explorers some issues surrounding the Affordable Care Act (ACA) in the U.S. and it’s impact and medical insurance and dental insurance and argues that dental insurance should be combined into dental insurance.

It says that the percentage of Americans lacking health insurance coverage has fallen to 9.2%, which is lower than pre-ACA levels. In addition more Americans than before now now have a personal physician, health care costs are growing at much lower rates, and amount out-of-pocket health spending is declining. The article states

“Earlier predictions that the ACA would cause dramatic increases in premiums, the elimination of health insurance coverage by employers, and a slowdown in the US economy have not happened. (emphasis added)”

Dental care in the ACA was implemented in a strange way. Dental care for children is 1 of the 10 essential health benefits under the ACA but has not expanded as Congress intended. Dental care for adults is not an essential health benefit under the ACA. The article states

“What is interesting, and ironic, is that a higher proportion of adults appear to be obtaining marketplace dental coverage, which was never an envisioned component of the ACA, compared with levels of children obtaining dental coverage, which was supposed to be an integral part of the law.”

The article later presents the fact that in 2013, 33% of adults and 12% of children had no form of dental insurance compared with 20% of adults and 6% of children who were lacking medical insurance. Further dental insurance rates have risen a lot for children but declined a bit for adults.

The author then argues that dental insurance does a relatively bad job of ensuring that adults get the care they need. Cost is the number one reason why people do not see the dentist. In fact number dental care usually ranks number 1 in terms of health care services people delay or avoid because of cost. The way dental insurance is
structured, which has the use of annual maximum benefits and significant coinsurance for services beyond preventive care, contributes to a high degree of cost barriers.

The author later presents three things that should change with respect to dental insurance. He believes the structure of the insurance should change to allow for better oral health. He also believes that dental insurance should incorporate some amount of risk such as for patients at high risk being eligible for a different set of services than low risk patients. The author also believes that dental insurance and medical insurance should be combined.

The author states

“Although the oral health community—and dentists in particular— firmly believe that “dental care is different” and walled off from the radically changing health care environment, I want to offer a reality check: consumers do not see it that way.”

Thus the author feels that it is time to rethink dental insurance and make it different than it has been in recent decades.

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