Dental Care Tops List of Insured Adults' Unmet Health Needs

Laird Harrison

October 02, 2015

Dental care is the most common healthcare need that insured US adults cannot afford, a new report shows.

One in five adults with full-year health insurance say they cannot pay the cost of dental care, write Adele Shartzer, PhD, and Genevieve M. Kenney, PhD, both from the Urban Institute, adding that "low- and moderate-income adults in particular face challenges affording dental care."

Published online September 24, the report is part of the institute's Health Reform Monitoring project, a quarterly internet-based survey of about 55,000 people. The most recent survey was conducted in March 2015. As of 2013, its reported margin of error for a 50% statistic with 95% confidence was ±1.3.

Dental care, at 20.1%, topped the list of unaffordable services in the survey, followed by prescription drugs (13.3%), medical tests of follow-up care (11.0%), medical care (10.4%), physician care (10.3%), specialist (9.6%), mental health or substance abuse treatment (5.6%), and contraception (2.0%). The proportion of adults with any unmet need for care was 28.2% overall.

The lack of dental care has persisted even as the Affordable Care Act has provided healthcare coverage to millions of Americans who were previously uninsured, the authors say.

Among adults with any unmet need, 28.9% reported that dental care was their sole unmet need. Another 42.5% reported an unmet need for dental care and some other type of healthcare.

The affordability of dental care is a particular problem for low-income adults with insurance, the survey found. Of this group, 30.8% reported an unmet need for dental care because of affordability.

The availability of dental coverage for adults contrasts with the availability for children. To receive federal funding, states must include pediatric oral health benefits in their Medicaid programs, but adult care is optional.

Oral health benefits are also available for low-income children, but not adults, through the Children's Health Insurance Program. And the Affordable Care Act lists oral health care as an "essential benefit" for children, but not adults. Dental care is not included in most Medicare plans.

But the difficulty of affording dental care was not limited to adults in poverty: Among insured adults with family incomes between 139% and 399% of the federal poverty level, 23.8% said they could not afford dental care.

Even among insured adults at 400% or more of the federal poverty level, 11.4% reported unmet need for dental care because of affordability.

The proportion of insured adults who cannot afford dental care is higher among those whose coverage was not provided by their employers, at 23.0% of adults with private, nongroup coverage and 34.9% of adults insured with public coverage, the survey showed.

"This is a nice update of a long-recognized problem," Burton Edelstein, DDS, MPH, professor of health policy and dental medicine at Columbia University in New York City, told Medscape Medical News.

For a long time, dental care has been difficult for many people to afford, in part because dental insurance provides only modest benefits, he said.

New kinds of dental care technology, such as dental implants and cosmetic treatments, are especially expensive, he noted. But dental insurance benefits for insured adults have not become more generous to match.

In fact, many employers have shifted the cost of the insurance to the beneficiaries. "So the gap between what they are being asked to pay and what they can afford to pay has increased," Dr Edelstein said.

The study was funded by Robert Wood Johnson Foundation, the Ford Foundation, and the Urban Institute. Dr Edelstein has disclosed no relevant financial relationships.

"QuickTake: The Forgotten Health Care Need: Gaps in Dental Care for Insured Adults Remain under ACA." Urban Institute. Published online September 24, 2015. Full text


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