ACA leaves gap between dental, medical coverage

Even though teeth and gums are just as much a part of the human body as kidneys, they are covered very differently by the American health insurance system.

As part of the healthcare reform law, Congress included a few provisions that may boost access to dental care. But the law does not include comprehensive coverage, and millions of Americans still lack access to a dentist. However, that’s not what a congressional panel was interested in last week when its members grilled CMS Administrator Marilyn Tavenner about how 400,000 dental plan enrollees got included in the 2014 Obamacare enrollment tally.

The reform law mandated pediatric dental services as one of its 10 essential health benefits, but adult dental services were excluded. All health plans must cover oral health risk assessments on a first-dollar basis for children up to age 10. The law also allowed states to expand Medicaid, which will extend dental benefits to more lowincome adults.

But large coverage gaps remain for those adults who don’t qualify for Medicaid. “It really only helped adults in a minimal way,” said Maxine Feinberg, president of the American Dental Association.

About 187 million Americans have some form of dental insurance, according to the National Association of Dental Plans. Coverage is mainly provided through employer plans, Medicaid and the Children’s Health Insurance Program. That leaves about 130 million people who have to pay for their dental care completely out of pocket or rely on supplemental dental policies. Traditional Medicare does not cover dental care unless it’s an emergency procedure performed during a hospital stay.

Lack of coverage, high costs and lack of access to dental providers can be fatal. In 2011, Kyle Willis, 24, died in Ohio after a wisdom tooth infection forced him to go to the emergency department. Willis had no insurance and couldn’t afford antibiotics.

Ultimately, the healthcare reform law is expected to bring some kind of dental coverage to 8.7 million children and 17.7 million adults by 2018, according to a Milliman analysis. Most of those people will get coverage through Medicaid expansion, although Medicaid dental benefits for adults vary widely by state. Of the states expanding Medicaid, only nine provide “extensive” adult dental benefits. And only one-third of practicing dentists accept Medicaid, an ADA study found.

Colin Reusch, a senior policy analyst at the Children’s Dental Health Project, said he hopes new value-based payment and delivery models will increase the focus on oral health and its connection to overall health.