If you haven’t already heard about the rising number of ER visits for dental injuries or other emergencies across the U.S., do yourself a favor and look it up. No time for that? Here’s a quick summary:
According to an April 2015 report published by the American Dental Association, trips to the ER due to dental conditions nearly doubled between 2000 and 2010, and the number continues to rise. Overall, ER visits have gone down for those aged 19 to 25 and remained about the same for children. The increased number of visits is by people aged 25 and older.
However, as investigative reporters across the country have shown, few emergency rooms are equipped to deal fully with dental emergencies. In many, perhaps most cases, ER patients with dental concerns are treated with painkillers and antibiotics, and are then referred to a dentist.
What is behind the rising number of dental ER visits?
Many issues are likely to be fueling the continued rise in the number of people who go to the ER due to dental
conditions. For one, insurers have traditionally separated dental coverage from health coverage, an incongruity that carried over and now affects how health benefits are defined in the Affordable Care Act. Dental and vision coverage for children is defined as one of the 10 essential health benefits, but dental coverage for adults is not required.
Medicaid attempts to ensure older Americans have adequate access to dental care, but compared to adults with private health insurance, adults with Medicaid are nearly 5 times as likely to have poor oral health. (Source: National Center for Health Statistics, 2012.)
Another piece of the puzzle is the lack of access to dental professionals in some rural or remote parts of the U.S. In many parts of the nation, there is an uneven distribution of dentists, which is having serious consequences. Kaiser Health News reported in 2013 that 16% of Americans live in areas with an insufficient number of dentists.
Federal guidelines, according to Kaiser, call for one dentist to every 5,000 people. Those who live in under-represented areas cope with the lack of dentists as well as they can, often by putting off or doing without necessary dental care until a trip to the ER is unavoidable.
What is being done to address the problem?
The increase in dental emergency room visits is straining the limits of emergency departments and costing far more than routine care and prevention would have cost. For example, it is estimated that for every dollar spent on children’s preventive care, between $8 and $50 could be saved on emergency treatment. (Source: Insuring Bright Futures: Improving Access to Dental Care and Providing a Healthy Start for Children.)
Dental schools, dentists, community health centers with dental clinics, dental associations, and non-profit organizations are doing all they can to provide help for people who have no dental coverage or who have poor access to dental professionals. Hardly a month goes by without at least one major free dental event being held somewhere across the U.S., and many smaller events are being held frequently, as well.
In addition, support continues to build for dental therapists. Proponents of creating this new type of “mid-level” dental practitioner say dental therapists can help to increase access to oral health care and free up dentists to do other, more critical work.
What can you do? Prevention is Key
At a policy level, the rise in ER visits for dental complaints indicates a need for more spending on adult oral health education and programs that support preventive dentistry for at-risk populations. On an individual level, understanding this situation should encourage more individuals to focus on preventing oral health problems long before they get out of control.
People with dental insurance are twice as likely to see a dentist as are those without a dental plan. (Source: National Institute of Health, 2010.) The generally low cost of dental insurance makes it highly affordable compared to emergency care.
In addition, many people who purchase dental insurance can benefit immediately. That is because dental insurance encourages, and generally pays for, regular check-ups.
Here are some of the key reasons why dental coverage is important to have, and – arguably – among the health benefits that should be considered “essential.”
- To Help You Pay for Costly Care: Dental care can be simple – such as a twice-yearly visit for a professional cleaning and x-rays – or it may involve costly care, such as oral surgery, getting a full set of dentures, or needing a crown. Depending on the type of dental insurance you get, dental plans generally pay either all or a percentage of the charges.
- To Help You Maintain a Healthy Mouth: Studies have shown regular dental exams and dental cleanings help people keep their teeth and gums healthy. In fact, most insurance plans pay 100% for check-ups every 6 months because the insurers know prevention is the key to cost-control.
- To Help You Protect Your Overall Health: The artificial barrier between oral health and health, period, is an illusion. Studies show our mouths can exhibit the symptoms related to more than 120 different non-dental diseases. So, even if there’s nothing wrong with your teeth and gums, regular visits to the dentist can help ensure early detection of serious diseases such as diabetes and heart disease. And that alone can make dental insurance well worth the investment.
And if you are a woman, you have even more reason to take charge of your oral health. That’s because, year after year, the percentage of U.S. women in the 18 to 64 age group who miss needed dental care due to cost is consistently higher than it is for men. (Source: National Center for Health Statistics, 2013.)
Many types of dental plans can help you take charge or your oral health, including dental health maintenance organization plans (DHMOs), discount dental plans or cards, and preferred provider organization plans (PPOs). To receive instant online quotes for plans available in your area, enter your zip in the box on our home page.
Why Dental Insurance is Important: Learn more about the top three reasons why dental insurance makes sense.
Common Causes of a Broken Tooth: Learn what to do in case of a dental emergency as well as the situations that need attention right away.
Knocked-Out Tooth: Learn what you can do to help make sure a tooth survives if it is knocked out.
Teeth are having a good run at the Supreme Court this year. SCOTUS has handed down decisions in two cases involving oral health during 2015.
In one of those cases, decided at the end of February, the North Carolina State Board of Dental Examiners challenged a lawsuit brought by the FTC and lost. The suit alleged the board had violated antitrust laws by barring non-dentists from providing teeth whitening services at mall kiosks.
It’s nice to know the folks in North Carolina can now enjoy low-cost teeth whitening where they shop, but there’s some really great news for US kids.
Here it is: When SCOTUS ruled this month that the ACA’s premium tax credits were not just for those who used a state-based exchange, it also helped pave the way to good oral health and better access to dental care for children.
Pediatric Dental Health and the ACA
According to the CDC, while for the most part preventable, tooth decay is still the most common chronic disease among US kids. The ACA, though, still has a chance to turn that around thanks to the Court’s latest decision.
While the ACA – like the insurance industry in general – oddly cuts off oral health coverage from coverage for the rest of the body, it does require some dental coverage for some citizens. Dental insurance for adults is not required under the ACA, but subsidized health plans must address at least 10 types of health care, the essential health benefits (EHBs). These include oral and vision services for kids.
Including dental coverage for children in the ACA was a huge step in the right direction. With the Court’s new decision on consumers’ eligibility for tax credits, millions of children can continue to reap the benefits, including healthy, happy smiles.
Affordable Care and Your Oral Health
The ACA provides a number of ways to purchase dental coverage. Some states include oral care benefits for kids within the health plans available on their insurance exchanges. Others separate out dental coverage as standalone products.
States may also define oral care benefits for adults as part of the EHBs for their citizens. Some roll those benefits into the health plans they offer. Others offer them as standalone parts of the benefits package.
Greater Consumer Choice and Enrollment Availability
You can obtain private dental plans both on and off the government-run insurance exchanges. For broader plan selection and the ability to enroll in a plan at any time, many people turn to the private dental marketplace. People that recognize oral health is not really cut off from general health, often enroll in a separate, stand-alone dental plan after they enroll in marketplace coverage.
For example, DentalInsurance.com provides consumers across the US with access to a very wide selection of dental coverage options. These include traditional dental indemnity plans, dental health maintenance organization (DHMO) plans, preferred provider organization (PPOs) plans, and even discount dental plans or cards.
We’ve made it easy for you to find individual dental insurance, dental coverage for yourself plus one other person, or even dental coverage for your whole family. To compare dental plans available in your area, simply enter your zip in the box on our home page.
Hooray for SCOTUS and the ACA! Now, be sure to exercise your constitutional rights to life, liberty, and the pursuit of oral health!
Learn more about the ACA.
Some people think buying dental insurance also means having to get a new dentist. The truth is, it depends.There are many dental networks in the US, and using a dental plan that has a network doesn’t always mean you will lose freedom of choice.
There are 4 basic types of dental plans: indemnity plans, dental health maintenance organizations (DHMOs), preferred provider organizations (PPOs), and discount dental plans. All but one of these types makes special arrangements with specific dentists to perform services at better rates for their plan’s members.
Those contracted dentists make up each separate plan’s “dental network.” There are dozens – if not hundreds – of dental networks today in the US.
Learn more about four types of dental plans.
Whether you will be able to keep your current dentist depends on the type of plan you choose.
The range of freedom depends on your choice of plan
Most dental plans restrict which dentists you can go to for services. On the side of free choice, you can see any dentist when you have an indemnity plan. At the other end of the spectrum, DHMOs and discount dental plans require that you only use their network dentists.
Then, there are PPO plans, the middle ground in the spectrum of dentist choice. Similar to DHMO and discount plans, PPO plans are built around a dental network. With many PPO plans, however, the use of out-of-network dentists may be allowed.
Then, there are PPO plans, the middle ground in the spectrum of dentist choice…
Depending on the PPO plan, you may be able to see a dentist who is not a member of the network and still have some part of your expenses covered or offset by the plan. The best savings, though, will always go to members who use an “in-network” dentist.
So if you’re one of those people who loves your dentist and wants to continue seeing them (we hope you are!), check with them to find out what plans and networks they take part in. If you don’t have a dentist yet, think about the other criteria that may be important to you, and choose a dental plan accordingly.
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