Confusion and Cost Create Barriers To Dental Coverage Plans

For years advocates have worked to share a message that Massachusetts knows well: Oral health is critical to overall health, and dental insurance is health insurance. The messaging looked like it would pay off when dental coverage for children was mandated by the ACA as one of 10 Essential Health Benefits that must be offered by compliant insurance plans. However, as illustrated by this NPR story, the route to expanded access to quality, affordable children’s dental coverage is not as foolproof as one would hope.

NPR’s Julie Rovner reports the gaping loophole present in the new law. Families aren’t required to buy dental coverage for their children when shopping through states’ health care marketplace exchanges. Though the coverage is technically mandated, there are no penalties for families who do not purchase it.

Further, the process by which families obtain pediatric dental coverage presents obstacles in and of itself that could impede families’ access to coverage. These obstacles are twofold: structural confusion and cost.

Both exist in Massachusetts, despite our Connector’s strong support for dental plans.

Because some plans in the marketplace include embedded pediatric dental coverage, while other plans require that coverage be purchased separately, there exists an underlying confusion and inconsistency. Secondly, because these stand-alone dental plans are not eligible for federally-sponsored subsidies, families face an economic disincentive to buy such plans—and the most vulnerable families (namely those with particularly tight budgets) may not be able to afford them at all.

With 1 in 10 children from low-income families suffering from untreated dental problems, the issue of access to dental care is both immediate and widespread. Though the ACA has laid a strong foundation by declaring children’s dental coverage one of its 10 essential benefits, there remains much to be done to ensure that the oral health needs of children across the state are equitably met.

-Jene Bass and Courtney Chelo

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5 Responses to Confusion and Cost Create Barriers To Dental Coverage Plans

  1. Nic says:

    I agree dental insurance is health insurance and should be a dental services should be made available to all. Dental health is very important to a person’s overall help so it should be bundled withing the coverage plans of other health and medical services.

    • Well said. Until provision is unified and incentives are aligned so biologic, biocompatible dentistry is the norm, we will continue to create health problems from dentistry as well as solve some of them. We really don’t need dentistry to be creating problems for genetically susceptible children and adults. We don’t force feed peanut butter at school.

  2. Pingback: What You Need to Know About Medicare beneficiaries in Medicare dental services

  3. We need to step back and look at the big picture when it comes to oral health. Families, employers, health plans, and governments would be far better off, improve health outcomes, and lower costs a lot if we had unified, integrated health, dental and mental health services and plans. Why? The U.S. lags much of the world in retiring and restricting dental amalgam from use.

    It is time to call for a Surgeon General Report on Dental Amalgam and Health Risks, and take the question of amalgam safely outside of the purview of the FDA, which refuses to follow the recommendations of its own Scientific Advisory Panels. Petitions for reconsideration were filed, public hearings were held around the country, nothing happened.

    Dental amalgam’s mercury toxicity is now proven to cause significant harm to genetically susceptible children and adults. This is 20%+ of the population, based on a half dozen gene types. Boys with CPOX4 experience immediate kidney damage and neurobehavioral deficits. Girls are protected by hormones, but develop problems as hormone and immune levels fall with age. Other genes associated with mercury toxicity include ApoE4 the Alzheimers gene, MTHFR mutations that affect methylation pathways, and more. Dentists have higher rates of Rx utilization than matched controls, and of suicides, hygienists of miscarriages. Patients with these gene types develop a raft of chronic diseases as they age.

    Pennsylvania requires its Medicaid program to cover alternatives to amalgam. This is essential for health, especially for children and adults with genetic susceptibilities. Private dental plans should be required to be cost neutral to offer plans in Massachusetts. Health plans and employers would have healthier employees and lower health care costs if they didn’t reap externalities of dental plans that are pennywise for themselves, and pound-foolish for others.

  4. Let’s step back and look at the big picture when it comes to oral health. Families, employers, health plans, and governments would be far better off, improve health outcomes, and lower costs if we had unified, integrated health, dental and mental health services and plans. Why? The U.S. lags much of the world in retiring and restricting dental amalgam from use.

    Join the call for a Surgeon General Report on Dental Amalgam and Health Risks, and take the question of amalgam safely outside of the purview of the FDA, which refuses to follow the recommendations of its own Scientific Advisory Panels in 2006 and 2010. Petitions for reconsideration were filed, public hearings were held around the U.S., but nothing happened.

    Dental amalgam’s mercury toxicity is now proven to cause significant harm to genetically susceptible children and adults. This is 20%+ of the population, based on a half dozen gene types. Boys with CPOX4 experience immediate kidney damage and neurobehavioral deficits. Girls are protected by hormones, but develop problems as hormone and immune levels fall with age. Other genes associated with mercury toxicity include ApoE4 the Alzheimers gene, MTHFR mutations that affect methylation pathways, and more. Dentists have higher rates of Rx utilization than matched controls, and of suicides, hygienists of miscarriages. Patients with these gene types develop a raft of chronic diseases as they age, which can miraculously fade when amalgam is safely removed per IAOMT protocols.

    Pennsylvania requires its Medicaid program to cover alternatives to amalgam. This is essential for health, especially for children and adults with genetic susceptibilities. Private dental plans should be required to be cost neutral to offer plans in Massachusetts. Health plans and employers would have healthier employees and lower health care costs if they didn’t reap externalities of dental plans that are pennywise for themselves, and pound-foolish for others.

    Only a full reboot of health, dental, mental health, insurance and regulatory systems can save us from ourselves in the US. The ADA fights tooth and nail to preserve its use and defend its never-earned reputation as a safe and effective restorative material. The APHA rolled back and did not renew its support for that policy which was pushed through by ADA allies late in 2012. Amalgam is banned in Denmark, Norway and Sweden, other nations have strong patient warnings and restrictions. Half of dentists don’t use it anymore, and many people think we banned it years ago.

    It’s time to make dental amalgam history, and help all of us get and stay healthier. I welcome the opportunity to present and discuss this with the Oral Health Coalition to help us learn more to best help those we seek to serve. For information, contact me at Hidden River Health Challenge: A Social Innovation Enterprise Promoting Health.

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