If you’ve ever had a tooth abscess, you understand pain. But, is that the kind of pain that sends you to a hospital’s emergency room (ER)?
ER visits for dental-related conditions is a trend on the rise.
- In 2009 – 830,590 Americans visited the ER for preventable dental conditions – a 16 percent increase from 2006
- In Florida alone – dental-related ER visits cost an estimated $88 million
The Pew Center for States website shares details of their recent study, A Costly Dental Destination. The director of the Pew Children’s Dental Campaign, Shelly Gehshan, was quoted as saying –
“The fact that so many Americans go to hospitals for dental care shows the delivery system is failing,”
With a focus on the high cost of medical insurance, dental insurance is often overlooked. Is it time to take a second look?
Dental is Different
In a former life, I was a dental hygienist. I left that life to work in employee benefits with insurance companies, brokerage and consulting firms.
You could say I’ve seen dental insurance on both sides of the chair.
- Dental insurance is a bit of a misnomer
- It doesn’t protect you from catastrophic losses
- It was never meant to
A Brief History
Fifty years ago, about the only coverage you found for dental procedures was on some major medical plans. And that was very limited – e.g., impacted wisdom teeth or the surgical removal of a tooth’s root tip (known as an apicoectomy).
In the 1960s and 1970s, dental insurance plans cropped up. They looked very similar to many of the plans in existence today.
- The intent was to provide limited financial assistance for dental procedures
- Plans divided procedures into Preventive, Basic and Major Services
- Plans typically covered preventive procedures at 100 percent
- Basic at a lower percentage (e.g., 80 percent)
- Major services at the lowest percentage (e.g., 50 percent)
- Basic and major services usually had deductibles
- There were numerous benefit limitations and exclusions
- There were annual maximums for the dollars paid by the plan (e.g., $1,000)
Dental Benefits Today
While scores of plans have evolved with networks of participating dentists, few plans provide comprehensive dental coverage.
A recent report from the National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA) offered the following snapshot of the dental benefits industry today.
- Only 1 percent of dental policies are purchased by individuals
- 81 percent have dental benefits through group policies (e.g.,employer coverage)
- Nearly 2 percent have dental benefits integrated with medical coverage
- 15 percent have dental benefits through public policies (e.g., Medicaid)
Dental Insurance’s Future
Despite evidence of links between dental disease and certain medical conditions, there remains barriers to accessing dental care.
- Many state Medicaid plans cover a limited amount of dental treatment (e.g., emergency dental care)
- Health Reform’s Affordable Care Act did not ignore dental, although much of it focused on children (“Pediatric Oral Services”)
- Most dental policies purchased by individuals have a minimum of a 12-month waiting period before major services, such as crowns, bridgework or dentures, are covered under the policy
- Generally, annual maximums on group policies offer little or no coverage of major services, such as crowns
Let’s face it, most people hate to go to the dentist. Then add in the sad state of the economy and the large out-of-pocket expenses from having inadequate or no dental coverage.
It could explain why the ER has become the dental office of the future.
Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician or dentist for health care issues.