Who has dental benefits today?

At year-end 2016, there were approximately 249.1 million Americans or 77 percent of the population with dental benefits[1]. The large increase in publicly funded benefits is primarily the result of improved CMS data on adults with access to Medicaid dental benefits.[2]

Two-thirds or 164.2 million Americans have private dental coverage. About 90% of Americans with private coverage get their benefits through an employer or other group program like AARP. Another 7.1% buy individual coverage[3] while just less than 3% obtaining dental benefits as part of a medical plan. Another 83.9 million Americans receive dental benefits through public programs like Medicaid, the federal Children’s Health Insurance Program, Medicare Advantage, and Indian Health Services.
Who has dental benefits today

Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care and experience greater overall health, according to the National Association of Dental Plans (NADP) report, The Haves and the Have-Nots: Consumers with and without Dental Benefits.

This report clearly shows that access to dental care is improved with dental benefits and that dental care improves oral health. Given increasing connections between oral and overall health, dental coverage is critical for all Americans. The choice for us as individuals and for our health care system is to pay for dental care now or pay more for medical treatment of dental complications later. (A “Consumer White Paper” based on data from this report can is available from NADP.)

Some 74 million Americans had no dental coverage in 2016. With the overall medically uninsured rate dropping to about 8.6% in the first quarter of 2016 as the result of the ACA; the dentally uninsured rate has increased to about 4 times the medically uninsured rate—even with dental coverage expansions. In part, this is due to the lack of dental coverage in traditional Medicare. Those over 65 may still have coverage through an employer, be able to purchase individual dental coverage or obtain dental coverage as a supplemental benefit through a Medicare Advantage plan. However only 52.9% reported having dental coverage on the 2016 NADP consumer survey while virtually 100% of seniors have medical coverage under Medicare.

Individuals without dental benefits are more likely to have extractions and dentures and less likely to have restorative care or receive treatment for gum disease. Furthermore, those without dental benefits report higher incidences of other illness; they are

  • 67 percent more likely to have heart disease;
  • 50 percent more likely to have osteoporosis; and
  • 29 percent more likely to have diabetes.

They also visit the dentist less frequently—missing the opportunity for prevention and early treatment. Many of them account for over 2 million visits to emergency rooms for dental treatment annually[4].

[1] 2017 NADP Dental Benefits Report: Enrollment

[2] NADP used data from 25 states that provide treatment for at least preventive services; states (13) with emergency only dental benefits were not included.

[3] While individual dental coverage is only 7% of total coverage in 2016, just 5 years ago in 2011 it was only 2% of coverage.

[4] The Healthcare Cost and Utilization Project (HCUP) National Emergency Data Sample

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