![\"https:\/\/pixabay.com\/en\/dentist-pain-borowa%C4%87-cure-nfz-428645\/\"](\"https:\/\/wp-media.patheos.com\/blogs\/sites\/533\/2017\/03\/dentist-428645_960_720.jpg\")
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There\u2019ve been a number of opinion pieces again recently on the question of whether it\u2019s appropriate for health \u201cinsurance\u201d plans to pay for routine expenses. \u00a0To a certain degree, high deductible plans attempt to return health plans to a true insurance model, covering the heart attack but not the doctor\u2019s visit for the flu, but even these plans, under ACA regulations, and, previously, in order to qualify for HRA status with a pre-tax reimbursement account for pre-deductible expenses, are required to cover various preventive care items, which were expanded under the ACA to include such predictable expenses as contraception. \u00a0And the notion of a health insurance plan covering routine expenses came from HMOs, which were technically labelled as \u201cprepaid health plans\u201d rather than insurance because of how they were structured. \u00a0(Oh, and I miss the HMO! \u00a0Everything was covered with tiny co-pays and the nuisance of having only in-network providers didn\u2019t really matter much, except that the practice group for my OB\/GYN switched to a hospital a 1\/2 hour drive rather than the one down the block for my second kid, and, for a brief period, that practice dropped out of network entirely.)<\/p>\n
But anyway: \u00a0consider dental plans. \u00a0The twice-annual check-up should likewise be a forseeable expense, no different than regular oil changes. \u00a0And fillings and extractions are probably about the cost of a typical minor car repair bill; as to more extensive dental procedures I\u2019m not sure, a bridge seems to be, at the lower end, about the cost of what I\u2019d pay for new brakes on the car.<\/p>\n
Do you need dental insurance? \u00a0Or are you better of taking care of your teeth, budgeting for regular dental check-ups, and using your rainy-day savings for any more expensive procedures that might be needed, in the same way as you would for other unexpected expenses?<\/p>\n
Note that\u00a0the ACA considers dental coverage for children as an \u201cessential health benefit.\u201d \u00a0But this plays out differently than other \u201cEHBs\u201d; each exchange is required to offer dental for children, either included in health insurance policies or as a separate dental policy, but\u00a0there is no requirement that a family purchase it along with the health insurance itself. \u00a0(See here, for instance<\/a>.) \u00a0But from what I can piece together, \u201cdental care\u201d is included in the way that subsidies are priced, so that it\u2019s subsidized, though a family could choose to spend their subsidy on a higher-benefit purely-medical plan instead.<\/p>\n Here\u2019s my\u00a0personal experience: \u00a0when I first started working at my current employer, back nearly 20 years ago, the company didn\u2019t offer dental insurance. \u00a0They said, \u201cdental care is a predictable, and not very high, expense, so we actuaries know that insurance doesn\u2019t make sense.\u201d \u00a0Some years later, they said, \u201cOK, we\u2019ll offer dental, but we won\u2019t subsidize it, because we think you, our employees, would rather we spend our benefit dollars on medical subsidies.\u201d \u00a0And later on, they said, \u201cOK, fine, to avoid issues of anti-selection, we\u2019ll begin to subsidize dental coverage, too.\u201d \u00a0Now, somewhere along the way, we did the math and concluded that the \u201cbasic\u201d plan which covered regular exams, X-rays, and routine fillings, was cheaper than the two dental appointments per year paid on a self-pay basis. \u00a0Now we are ourselves the anti-selecting customers, since we\u2019ve upgraded to the comprehensive plan for as long as we\u2019ve got kids in braces, but the additional benefits only just barely make up for the increase in premiums anyway.<\/p>\n Here\u2019s a news report: \u00a0\u201cER visits for dental problems on the rise<\/a>,\u201d in the USA Today, back in 2015.<\/p>\n Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket. And the 10 percent of American adults with Medicaid dental plans often can\u2019t find dentists to take them. The ADA says that\u2019s partly because reimbursements are so low \u2014 41 percent of private insurance reimbursement in Kentucky last year. . . .<\/p>\n People pay a price for going without dental care. Federal figures show that about four in 10 adults nationally had no dental visit in the past year, and more than a quarter of working-age adults, and one in five seniors, have untreated cavities.<\/p>\n When poor people do get care, dentists say, the uninsured usually opt for the cheapest available and Medicaid patients usually choose only basic, covered services such as extractions.<\/p><\/blockquote>\n And here\u2019s a report, \u201cDental Caries (Tooth Decay) in Adults (Age 20 to 64)<\/a>.\u201d \u00a026% of adults ages 20 \u2013 64 have untreated cavities. \u00a0And while rates of tooth decay are lower\u00a0for younger adults \u2014 an average of 6.16 missing, decayed, or filled teeth for the age group 20 \u2013 34 years, vs. 15.05 for the age group 50 \u2013 64 years \u2014 it\u2019s hard to know how much of this is because of the impact of fluoride toothpaste and fluoridation of drinking water, vs. just the fact that the younger group has had fewer years in which to acquire tooth decay. \u00a0A Today article<\/a> based on this report also says that rates of tooth decay among children are increasing, possibly due to the increase in bottled-water (vs. tap water) consumption.<\/p>\n The problem is, then, ultimately, not\u00a0a matter of dental insurance<\/em>. \u00a0It\u2019s a matter of providing government-paid dental care<\/em> to low income people, because in some cases, they may well do whatever it takes to get that car repair taken care of, whether it\u2019s a payday loan or borrowing from whoever they can or pawning an item, but they won\u2019t treat their teeth as such an urgent need, or because, in other cases, they genuinely don\u2019t have any money at all, and there exists no \u201cdental stamps\u201d to pay in the way that food stamps pays for food for the cashless.<\/p>\n Exactly where the cut-off is between \u201ctoo poor to self-pay dental expenses\u201d and \u201cresponsibly writes the check to the dentist twice a year\u201d is, I don\u2019t know. \u00a0The report above says that 43.88% of those below the poverty line have untreated tooth decay, vs. 39.31% of those with incomes 100% \u2013 200% of the poverty line, and only 17.97% of those above 200%. \u00a0How much of a further drop-off we\u2019d see if the report showed further gradations of income, I don\u2019t know. \u00a0Blacks also had twice the rate of untreated tooth decay as whites \u2014 40.45% vs. 20.84%.<\/p>\n And the USA Today article reports that the consequences of lack of dental care can be substantial; in extreme cases, untreated cavities produce infections which send people to the ER. \u00a0In other cases, people end up with missing teeth because dental treatment is delayed for so long.<\/p>\n (Ugh! \u00a0Just typing this makes me want to go upstairs and brush my teeth!)<\/p>\n So what do we do? \u00a0Do we say, \u201cpeople should be responsible enough to take care of their teeth\u201d? \u00a0Do we say, \u201cthe government should pay for everyone\u2019s dental care because too many people will not, or cannot, self-pay\u201d?<\/p>\n In any event,\u00a0I thought it would be useful to think about dental care, as a different way of thinking about even the more predictable elements of healthcare.<\/p>\n \u00a0<\/p>\n Image: \u00a0https:\/\/pixabay.com\/en\/dentist-pain-borowa%C4%87-cure-nfz-428645\/; public domain<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":" There\u2019ve been a number of opinion pieces again recently on the question of whether it\u2019s appropriate for health \u201cinsurance\u201d plans to pay for routine expenses. \u00a0To a certain degree, high deductible plans attempt to return health plans to a true insurance model, covering the heart attack but not the doctor\u2019s visit for the flu, but […]<\/p>\n","protected":false},"author":2209,"featured_media":6283,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[588,589,356],"class_list":["post-6276","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-dental-care","tag-dental-insurance","tag-health-insurance"],"yoast_head":"\n