The only thing I hate more than going to the dentist is paying the bill. At least it’s covered by insurance, or is it? It turns out that your coverage depends on the quality of your private insurance through your employer’s health care plan, if any, or your eligibility for Medicaid benefits.
PRIVATE INSURANCE
A 2002 study found that fifty-one percent of those surveyed had private dental coverage, with the annual dental cost for these covered individuals averaged about $500.00. In 2006, the percentage of those covered has remained static while the cost of the same dental services rose to $655.00. So where do those who are covered get there insurance, and how can you get it? Good questions.
First, it’s important to understand why dental care is treated differently than standard health insurance. The big reason is that most dental care focuses on preventive care. Dental problems are, typically, easily prevented with regular checkups and maintenance. This is unlike many medical conditions that can strike without warning. Because health care coverage has focused so long on the catastrophic, preventive medicine was always been pushed aside.
Studies have shown, though, that unless individuals have dental coverage, most (more than two-thirds) won’t go to the dentist. These individuals miss out on preventive dentistry, suffer problems, and end up costing the health care industry a bundle in emergency treatment.
Last month’s Washington Post story about Deamonte Driver illustrates the point in a heart-breaking way. Deamonte developed a tooth infection that could have been prevented and which a simple $80 extraction could have cured. However, it went untreated and spread throughout his mouth and into his brain, killing him six weeks later. Had Deamonte had basic dental coverage, annual preventive checkups would have avoided the problem. Had Deamonte had basic dental coverage, the $80 extraction would have not been a problem. Had Deamonte had basic dental coverage, a $250,000.00 last-ditch effort to save his life would not have been necessary. Deamonte Driver’s story might be extreme, but it isn’t unusual. Dental health isn’t elective or unnecessary. Dental health is an important part of overall health care, period.
There are a lot of Deamonte’s out there and the health care industry is taking notice. One study suggests that preventative dentistry saved nearly $100 billion in health care costs in the 1980s. As a consequence, more individual and employer health care plans are offering dental insurance as an “add-on” to their basic health care coverage.
Typically, dental coverage is not “folded-in” to the basic coverage offered by your employer. You will likely have to pay an additional premium to add it. The average premium is around $200.00 for a year of coverage for a single individual. I’ve seen premiums as low as $72.00 and as high as $2000.00. Co-pays also vary widely from $0.00 to $25.00 for the most part. However, compared to the annual costs of even basic care (approximately $600 per individual per year), the cost of coverage can be a bargain.
In addition to employer-supported plans, there are other private plans available. Individuals may choose to self-insure or may go through another group plan offered by an organization such as AARP.
There are several issues you should take into consideration when evaluating private plans. First, how are you allowed to choose your dentist? Is it an open (you choose any dentist) or a closed panel (you select from a insurer list)? Second, what are the exclusions or limitations on the type of treatment(s) covered. In other words, does the plan cover diagnostic and preventive treatments? Third, what is the patient contribution (co-pay), if any? Fourth, are there annual caps on the total cost of your dental care? Also, remember that there might be overlap between your regular health insurance and your dental coverage. Will you be able to take advantage of that overlap?
According to Quotit Corporation, an insurance industry support provider, dental coverage should be evaluated by lumping services into three broad categories and determining what percentage the coverage will pay in each. The first category is basic care and should be covered 100%. These services include initial oral examination, teeth-cleaning, x-rays, fluoride treatment, and sealants. The second category is routine corrective treatment and should be covered 70-80% by good plans. These services include restorative care (fillings, crowns, etc.), root canals, minor surgical procedures (e.g. tooth removal), periodontics (e.g. lesions), and denture/bridge repair. The third category is major dental care and most plans will cover less than 50% and have annual caps. These services include major oral surgery, orthodontics, and dental implants.
MEDICAID
For those who are unemployed or underemployed and don’t have access to private plans, their only option may be Medicaid. The Medicaid program of the federal Social Security Act is a set of national healthcare standards that are implemented by each state. The coverage is available to low-income individuals and families who meet each state’s guidelines. Most states now include dental care options.
The dental coverage standards are categorized by age, those twenty-one and older are in an optional category, and those under the age of twenty one are in a separate mandatory category. Under the law, states may choose to offer dental coverage to adults, but must offer dental coverage to those under twenty-one. The available coverage includes annual exams and treatments, restorative, emergency, and any other “medically necessary” treatments. What constitutes “medically necessary” is defined by the law of each individual state.
Unfortunately, finding dentists who accept Medicaid can be difficult. For more information on the availability of dental coverage through Medicare and Medicaid, contact the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. There website is located at www.cms.hhs.gov.
Cited Sources:
Private dental coverage: Who has it and how does it influence dental visits and expenditures?” by Dr. Manski, Mark D. Macek, D.D.S., Dr.P.H., and John F. Moeller, Ph.D., in the November 2002 Journal of the American Dental Association 133, pp. 1551-1559.
and
http://www.quotit.net/resources/what_dental_plan_to_buy.htm accessed 3/29/2007