Adults with health insurance are still experiencing barriers to dental coverage

It is not surprising that uninsured adults might have unmet needs for dental care, but, according to a report on the Urban Institute’s Health Reform Monitoring Survey (HRMS), adults with full-year health insurance coverage have also said they have unmet dental care needs (citing the Kaiser Commission on Medicaid and the Uninsured 2012; Long et al. 2012). Despite the fact that access to health insurance was greatly expanded by the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) many Americans are experiencing the same financial barriers to dental services they encountered prior to the ACA’s passage, the Urban Institute has found.

The HRMS tracks health care access and affordability, including unmet needs for dental care because of affordability in the past 12 months, and the most recent report on the HRMS from the Urban Institute’s Health Policy Center focuses on nonelderly adults (ages 18 to 64) who have had insurance coverage for all of the past 12 months, using data from the March 2015 HRMS, just over one year after implementation of many of the ACA’s major insurance coverage provisions.

Why many workers still don’t have dental. Dental coverage for children, but not adults, is included in Medicaid’s “benchmark benefits” for individuals newly eligible under the ACA, the Urban Institute points out, adding that the list of essential health benefits that must be covered by qualified private health plans does not include dental benefits. Although many employers offer dental coverage, fewer workers have access to dental coverage through work than have access to health coverage through work. The Urban Institute says that, according to one source (Wiatrowski, William J. 2013. “Employment-Based Health Benefits in Small and Large Private Establishments.” Beyond the Numbers 2 (8). Washington, DC: Bureau of Labor Statistics), 45 percent of workers in private industry were offered dental benefits in 2012 compared with 70 percent who were offered health benefits. Even workers with good dental coverage can have difficulty obtaining dental care, especially if they are in underserved or rural areas, the report continues (Allison, R. Andrew, and Richard J. Manski. 2007. “The Supply of Dentists and Access to Care in Rural Kansas.” Journal of Rural Health 23 (3): 198—206).

The March 2015 data show that dental care was the most common service for which full-year insured adults reported unmet needs because of affordability, and this matches patterns in existence prior to the implementation of the ACA. Furthermore, 20.1 percent of even full-year insured adults reported an unmet need for dental care because of affordability, indicating that even those with health insurance coverage experience challenges with regard to finding affordable dental care. Seventy-one point four percent of adults with any unmet needs based on affordability said that they had had an unmet need for dental care; 28.9 percent of such adults reported dental care as the sole area of unmet need, and 42.5 percent reported an unmet need for dental care plus some other type of health care.

Affordability is key. Low-income adults covered for the last 12 months by health insurance were particularly challenged when attempting to obtain affordable dental care. Just over 30 percent cited affordability as the problem, although dental care affordability issues were also common among insured adults with higher incomes. For example, 23.8 percent of adults with family income between 139 and 399 percent of the federal poverty level (FPL) and 11.4 percent of adults with family income at or above 400 percent of FPL reported unmet needs for dental care because of affordability.

Hispanic adults with health insurance for the previous 12 months were more likely than similarly insured adults of other racial and ethnic groups to report unmet need for dental care because of affordability, and women were more likely than men to have unmet dental needs. The Urban Institute also found that adults insured with coverage other than employer-sponsored insurance were more likely to report unmet needs for dental care, including 23.0 percent of adults with private, nongroup coverage and 34.9 percent of adults insured with public coverage. The Urban Institute theorizes that this may be due to the greater availability of supplemental dental coverage for those with employer-sponsored insurance than for adults with Medicaid or nongroup coverage.


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