Reducing Dental Benefits Is Expensive

You just can’t run away from dental care problems, according to a new study that reviews the costs associated with California’s cuts in the state’s public dental coverage.

When California cut comprehensive dental coverage from the state’s public health insurance plan, in an attempt to control health care costs, emergency room visits for dental problems rose sharply, increasing by nearly 1,800 additional ER visits per year. And average yearly costs associated with dental emergency room visits increased by 68 percent.

The study “Eliminating Medicaid Adult Dental Coverage In California Led To Increased Dental Emergency Visits And Associated Costs,” was published in Health Affairs, a health policy, peer-reviewed journal.

Astha Singhal, the study’s lead author, stresses that the study’s findings are particularly critical now, as U.S. states either expand or consider expanding their Medicaid programs under the 2010 Affordable Care Act (ACA). Only 15 states currently offer extensive Medicaid coverage for adult dental services.

The American Dental Association (ADA) estimates that emergency room visits for preventable oral health-related visits costs the U.S. health care system as much as two billion dollars per year.

The ADA goes on to state that “Without further interventions from policy makers, dental emergency department (ED) visits are likely to increase in the future, straining the health care system and increasing overall health care costs.”

Medicaid and Dental Coverage

According to, states are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP), but may choose whether to provide dental benefits for adults.

While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.

California Medicaid eliminated its comprehensive adult dental coverage in July 2009. Singhal’s research team examined the impact of this policy change on emergency department visits by Medicaid-enrolled adults for dental problems in the period 2006–11 – three years prior to the reduction in coverage and two years after.

“We found that the policy change led to a significant and immediate increase in dental ED use, amounting to more than 1,800 additional dental ED visits per year. Young adults, members of racial/ethnic minority groups, and urban residents were disproportionately affected by the policy change,” the study’s synopsis notes.

“Average yearly costs associated with dental ED visits increased by 68 percent. The California experience provides evidence that eliminating Medicaid adult dental benefits shifts dental care to costly EDs that do not provide definitive dental care. The population affected by the Medicaid adult dental coverage policy is increasing as many states expand their Medicaid programs under the ACA. Hence, such evidence is critical to inform decisions regarding adult dental coverage for existing Medicaid enrollees and expansion populations.”

Emergency Rooms Can’t Replace Dentists

Eliminating Medicaid Adult Dental Coverage In California reported that the most common dental-visit diagnosis in the ER was “other dental disease,” which indicates disease within the tooth, gum problems, and cavities.

According to a report by Reuters, Dr. Peter Damiano, the study’s senior author, said that the state’s Medicaid program likely still paid for some of the care people received in the ER for dental problems, because it’s often billed as medical services.

“They’re usually giving them antibiotics and some pain killers,” said Damiano to Reuters. “The money being spent on them at the (ER) is basically being wasted.”

Medication may help people cope with the immediate physical effects of dental disease – abscesses, pain, infection – but don’t necessarily fix the true cause of the problem. But since the symptoms fade, people delay care as their condition worsens. The end result: increased expense for more complex treatments, and potentially compromised health.

California has recently reinstated some of the Medicaid dental benefits that were cut in 2009, but other states are currently looking at possible dental benefit cuts.

Dental Insurance And Obamacare

The Affordable Care Act does expand pediatric benefits, but many children already had access to such benefits through Medicaid and Children’s Health Insurance Program (CHIP). For adults, the law does not include dental benefits as part of the Essential Health Benefits. So, this leaves most adults having to pay for a stand-alone plan on top of their medical insurance, either through the healthcare marketplace or privately, or paying for their dental care out of pocket.

According to the American Dental Association “unfortunately, the Affordable Care Act (ACA) did little to address the issue of dental utilization in emergency departments. The ACA does not mandate dental benefits for adults, nor are dental benefits likely to be included in the essential benefit packages in insurance plans sold through most states’ exchanges under provisions of the law.”

“Recent research has also shown that the ACA will not dramatically increase access to dental benefits for poor adults through Medicaid and will have little impact in providing adult private dental coverage through the exchanges.”

The most recent figures available indicate that approximately 187 million Americans, or 60 percent of the population, have dental insurance. About 9 percent of dental benefits are provided through an employer or other group programs like AARP. Group coverage also includes public programs like Medicaid, the federal Children’s Health Insurance Program, and TriCare which provides coverage for the military.

Affordability is, unsurprisingly, a significant issue for the uninsured. According to the :DentalPlans SmileIndex™ survey, 58 percent of the respondents without coverage stated that dental insurance was not affordable.

Only seven percent of those surveyed for the SmileIndex survey get their dental insurance as a result of the healthcare exchange law. It’s obvious that, while the Affordable Care Act has reduced the number of people without medical insurance, it has done little to broaden access to affordable dental care for most Americans.

Lack of affordable care has significant consequences. One in four Americans over the age of 65 has lost all of their natural teeth due to decay and lack of access to affordable treatment, according to the American Dental Association.

Dental health is increasingly tied to overall wellness. Untreated periodontal (gum) disease will destroy gums and bones. Oral infections have also been linked with diabetes, heart disease, stroke, respiratory, infections, breast cancer and premature births. Additional studies on the connections between periodontal and other diseases are being conducted, but it’s safe to say that dental care is critical to maintaining good health. Call us at 1-800-238-5163 to find out about how dental savings plans can help make quality dental care affordable.



*A national study was conducted for :DentalPlans between Jan. 1 and Jan. 7,  2015 by Infosurv Research.  A total of 1,200 national respondents were surveyed, yielding data with a margin of error of +/- 2.83%.

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