Adults With Insurance May Have Unmet Dental Needs

From the WebMD Archives

By Michelle Andrews

Dental care ranked number one among health care services that people with insurance say they’re skimping on because of cost, a new survey found.

One in five adults reported that they had unmet dental care needs because they couldn’t afford necessary care, according to the brief by researchers at the Urban Institute’s Health Policy Center. People said they were more likely to go without dental care than prescription drugs, medical care, doctor or specialist care, and medical tests.

The dental brief is based on the March 2015 Health Reform Monitoring Survey, a nationally representative quarterly online survey of 7,500 adults between the ages of 18 and 64. Respondents all had health insurance for the 12 months prior to the survey, but dental insurance is often sold separately from medical insurance, and many employer-provided benefit plans do not include dental coverage.

“The level of unmet need for care was surprising,” says Adele Shartzer, a research associate at the institute’s health policy center. “We expected that [dental care] would be a little higher than the other services we asked about, but it was even higher than we expected.”

People with lower incomes were more likely to report unmet dental needs, with 31 percent of adults with incomes up to 138 percent of the federal poverty level (or $16,243 for an individual) affected. But the problem persisted at higher incomes as well: 24 percent of people with incomes up to 400 percent of poverty (or $47,080 for an individual) and 11 percent of those with incomes above that also reported needing dental care but not being able to afford it.

The health law requires that health plans offer dental coverage for children as one of the so-called essential health benefits. But there’s no requirement that plans offer adults coverage for dental care.

In 2014, 53 percent of employers that offered health insurance also offered dental coverage, according to the Kaiser Family Foundation’s annual employer health benefits survey. That figure is basically unchanged from 2012, when 54 percent of employers offered dental coverage. [KHN is an editorially independent program of the foundation.]

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Dental insurance, even if available, is limited. Benefits are typically capped at $1,000 or $1,500 in services annually, according to the National Association of Dental Plans. Regular office visits for cleanings and X-rays are generally covered at 100 percent, while fillings and other basic procedures are covered at 80 percent. Plans typically pay just half of the cost of major procedures such as crowns and inlays.

In 2013, the average cost for an oral exam ranged from $49 to $105, according to the American Dental Association’s annual survey of dental fees. X-rays cost up to $505. Fillings cost between $86 and $326, depending on how many surfaces were covered, while crowns cost from $962 to $1,070, the survey found.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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