Why Aren't Your Teeth Covered by Your Health Insurance?

Dental care is important. However, many Americans aren't getting the dental care they need, and it's not simply because they're afraid of the dentist's chair. 

More than 17 percent of children from 5 to 19 years old have cavities and so do more than 27 percent of adults, according to the Centers for Disease Control and prevention. Nearly 50 percent of American adults have periodontal disease, or oral infections. 

However, dental procedures cost money and the vast majority of them are not covered by standard health insurance, but instead are covered under separate dental insurance plans. Although the Affordable Care Act requires insurance marketplaces to offer dental plans for children, it doesn't require dental plans for adults. 

But why is dental insurance separate from medical insurance? 

There doesn't seem to be any one reason, but the history of dentistry started separately from the medical profession, according to a 2014 piece by The Atlantic's Olga Khazan. 

"The partition between dentistry and the rest of medicine dates back to the dental profession’s roots as an offshoot of hairdressing. Until the 1800s, barbers served as rudimentary dentists, pulling painful teeth and lancing abscesses after they finished trimming whiskers. In earlier centuries, people would see barbers for occasional bloodletting (thought to be therapeutic at the time)—hence the red-and-white striped pole."

The division between medical doctors and dentists has continued into modern times, according to Joseph Errante, DDS, senior associate dean for clinical affairs at Columbia University's College of Dental Medicine. 

"The profession in general has always felt that they wanted to be separate and there's probably a whole lot of philosophical reasons," he said. 

He said the division led to separate insurance products for medical problems and dental problems. Dental insurance is more of a benefit than actual insurance, according to Errante.

"Dental insurance is more of a financial product than a health product," he said. "You give me some money, and I give you a benefit that caps out every year. It's not really designed to pay for a catastrophic event."

When Congress formed Medicaid and Medicare in the 1960s they didn't include dental insurance in the coverage. 

The division can be a big problem for low-income Americans on Medicaid and elderly people on Medicare who can't pay for dental plans. 

"Low income adults and adults in Medicaid tend to go to emergency rooms when they have a toothache or a dental problem and the emergency room doesn't treat it," he said. "They get some pain medication and some antibiotics and a large bill. It doesn't really treat the problem."

Errante said that dental care should be a part of medical insurance so that everyone can have access to the care they need. 

"At Columbia we kind of do have the philosophy that dentistry and oral health is another specialty of medicine," he said. "I strongly feel that we should be integrated."

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