Does Health Insurance Cover Dental

By examining your mouth, a dentist can identify issues related to other parts of your body. A Doctor of Medicine in Dentistry (DMD) can detect signs of kidney disease, diabetes, cancer, heart disease and other disorders. Yet, the Centers for Disease Control and Prevention (CDC) reports that “more than 1 in 4 (26%) adults in the United States have untreated tooth decay.”

Lack of treatment may be partially attributed to the fact that medical insurance does not cover routine or comprehensive dental care. Health insurance companies are known to limit coverage to medically necessary services. Your medical insurance may cover:

Oral health issues caused by diseases, such as diabetes and osteoporosis
Dental injury caused by trauma like a car accident or sports injury

Dental versus medical insurance

The Patient Protection and Affordable Care Act (ACA) requires that certain health insurance plans cover, at minimum, 10 service categories, known as essential health benefits. These services include inpatient and outpatient care, prescription drug coverage, mental health, pediatric services and more.

All policies sold in the Health Insurance Marketplace as well as small group plans and individual policies must provide essential health benefits. Oral care is included in pediatric services, but insurers are not required to offer dental coverage to adults.

How to get dental insurance

Some health plans sold include dental coverage. If covered, you pay one premium for both medical and dental coverage. You can also shop for stand-alone dental plans as well. If you are employed, your employer may offer a dental plan separate from your medical insurance. In that case, you may be able to enroll family members as well as yourself. If you have Medicare, research Medicare Advantage (MA) plans in your area. Most MA plans include dental coverage.

When you shop for dental plans, be sure to distinguish between dental insurance and dental discount plans, also known as dental savings plans.

Dental insurance versus discount (savings) plans

Dental insurance:

You pay a monthly premium and get an insurance card.
Your dentist bills the insurer directly.
You are responsible for applicable deductible and coinsurance payments.
You are allowed a certain number of visits per year.

Dental discount plans:

You pay an annual fee and get a membership card.
If you use a dental network provider, the dentist bills you at a reduced rate according to the plan.
You pay the dentist directly.
Dental visits are not limited.

Dental insurance in the future

The Mayo Clinic advises that lack of oral health can contribute to certain diseases because “your mouth is the entry point to your digestive and respiratory tracts.” Conditions linked to oral health include endocarditis, cardiovascular disease, birth complications and pneumonia.

Some dental professionals are trying to drive the health care insurance industry to include dental coverage. A strong argument in favor of removing the separation between medical and dental care is clear. Insurers may realize potential savings if dental care leads to reduced emergency-room visits, which occur when neglected oral health manifests into severe issues.