This Health Policy Solutions article by Sara Schmitt is a compelling look at the need for expanded dental insurance in Colorado. Many people in Colorado get dental insurance through their employers. But a lot of people who either don’t have access to an employer group dental plan, or who must fund it with a payroll deduction, opt to forego dental coverage. Sara’s article notes that more than 2 million Coloradans who do not have dental insurance – that’s out of a population of just over 5 million people, so it’s a significant portion of the state.
It’s often the case that dental insurance doesn’t seem to be a worthwhile purchase from a strictly mathematical perspective. If you’re just looking for a policy to cover semi-annual checkups and cleanings, it basically amounts to a pre-paid plan: you pay as much in premiums as you’d spend if you just paid the dentist directly, especially since routine dental care can often be discounted with the coupons and special offers that pour into our mailboxes. And if you do end up needing more extensive dental care, most dental insurance policies have an annual cap that averages about $1000. So if you need a filling or a crown, you’d be ok. But if you need implants or significant bridge work, you’d still be paying most of it out of pocket.
This is in stark contrast with health insurance. There’s no such thing as “catastrophic” dental insurance. You can’t buy a plan with a $1000 deductible that will cover your bills in the event that you need $15,000 worth of implants. With most dental plans, you know for sure that the maximum benefit you’ll ever get from the plan in a given year is about a thousand dollars. With a health insurance plan, we have no way of knowing how much the plan might benefit us – and the total could be astronomical (and completely crippling if faced without health insurance).
Taking all of this into consideration, a lot of people choose to skip dental insurance. Their plan is to pay out of pocket when the go to the dentist for cleanings and check ups, and the idea is that they will end up about the same – or a little ahead – financially in most years.
But the problem is that a lot of those people end up not going to the dentist at all. Sometimes they simply cannot afford it (and might not have been able to afford dental insurance either), but sometimes it’s just a case of not wanting to fork over a triple-digit chunk of change in trade for an experience that most of us don’t enjoy. If a person has dental insurance, it feels like the checkups and cleanings are free (even though that’s not the case – you’re paying for them with your premiums, spread over the whole year), and the fact that you’re paying premiums makes you feel like you better go get your cleanings because otherwise the premiums feel like a waste of money. There are ways to make it work with self pay, including setting aside the money you would be paying for dental insurance into a separate account each month, and then using that money when it’s time for your checkups and cleanings. But the fact remains that people are a lot more likely to visit the dentist for routine and preventive care if they have dental insurance.
As Sara’s article points out, this is about more than just teeth. Neglected teeth and gums can cause other health problems, and dental issues can also be warning signs or complications of seemingly-unrelated diseases. Dentists also screen for oral cancer (treatment of cancer falls under health insurance coverage, but detection of oral cancer is often done by dentists).
One possible solution would be for dental insurance to get wrapped in to health insurance policies, both private coverage and Medicare (the majority of seniors in Colorado have no dental insurance, because it’s not part of Medicare). If dental insurance were absorbed into health policies, the premium increases might not be significant. Maternity coverage is a good example of how this could work. In the past, maternity coverage was only available on a few individual health insurance policies in Colorado, as a separate rider that had to be added to the basic coverage. The cost for this rider was prohibitive, because the only people who were adding it were the ones who were planning to use it. But for almost two years now, all new individual policies in Colorado have included maternity coverage, and premiums have definitely not increased by as much as maternity riders used to cost (premiums have gone up, as they had done for years prior to the maternity mandate, but there are many factors involved). If dental coverage were included in health insurance policies, the administrative overhead for these plans could be rolled in with the administration of the health plans, and there would be more people who had coverage and weren’t using it often – their premiums could offset the cost of dental care for people with significant claims.
If you have ideas for expanding dental insurance coverage – or increasing the number of people who are proactive in maintaining their dental health, regardless of insurance status – please share in the comments or on Twitter (Jay or Louise).