Affordable Health care Dental
Obamacare is a boon for boomers in various ways. Dental coverage, alas, isn’t one of them.
More Americans lack dental coverage than health insurance, and while dental bills rarely reach the stratospheric heights of medical bills, they can still take a big bite out of retirees’ savings. But while the Affordable Care Act has created a new way to shop for dental insurance, it hasn’t improved the quality of that coverage, nor has it made the economics any friendlier—at least not for adults.
For the most part, Medicare doesn’t cover dental care; the program pays only in certain cases where dental and medical needs intersect. And only 2% of retirees have dental coverage through a prior employer, according to Oral Health America, a Chicago-based nonprofit that works on dental access and education issues. Nationwide, 126.7 million Americans lack dental coverage, nearly three times the number of medically uninsured, according to the National Association of Dental Plans.
The stakes for this coverage gap are high when it comes to your health and your wallet. Not only are dental problems costly and painful in their own right, but inadequate dental care can negatively impact your overall health.Shutterstock.com If that screen is showing healthcare.gov, chances are the patient is confused. The Affordable Care Act’s health exchanges haven’t offered much help to adults who lack dental coverage.
To name just a few examples: Diabetes can contribute to gum disease, which in turn may exacerbate diabetes. Studies have also suggested a link between gum disease and increased stroke risk. Weak teeth can make it harder to eat a nutritious diet, worsening overall health, said Dr. Charles Norman, president of the American Dental Association.
Even those with dental insurance will find themselves on the hook for a potentially big share of the bill when their needs are more-than-routine. The typical dental plan—offered through an employer or on the individual market—pays between $1, 000 and $2, 000 in annual benefits per patient. That might be fine for the young and cavity-free, but it doesn’t go so far if you need a full set of dentures at more than $3, 000, or a mouthful of implants at $4, 000 per tooth.
In this respect, dental coverage differs from medical coverage. The Affordable Care Act, informally known as Obamacare, imposed annual caps on patients’ out-of-pocket costs for medical care within their plan network. Previously, some plans on the individual insurance market didn’t have any spending limits at all, leaving patients vulnerable to financial ruin in the face of a devastating illness.
What’s more, Obamacare banned discrimination based on health status. People with pre-existing conditions (and it’s the rare boomer who doesn’t have at least one) can no longer be charged more on the individual insurance market for health coverage or denied coverage altogether.
Yet with most dental plans, the tooth you lost before you enrolled is your problem; the plan generally isn’t going to cover anything in conjunction with that missing tooth.
Why dental is different
So why is Obamacare toothless when it comes to adult dental benefits? The law named pediatric dental benefits one of 10 essential health benefits, which starting this year must be included in certain health plans. The law imposes annual out-of-pocket caps on certain pediatric dental expenses, limiting families’ financial exposure.
But those benefits don’t extend to adult dental. Medicare doesn’t cover routine dental care, and “that inertia spilled over into the ACA, ” said Dr. David Krol, senior program officer at the Robert Wood Johnson Foundation, a philanthropy devoted to health and health care.