Dental and Medical Insurance: An Argument for Integration

Dental and Medical Insurance: An Argument for Integration

In the United States, dental care has always been separated from medical care, even though oral health and general health are intertwined. Oral health plays a part in ailments such as cardiovascular disease and endocarditis, and it is conversely affected by conditions such as diabetes and osteoporosis.1 Additionally, oral health functions—like chewing, smiling, and speaking—are major factors in one’s self esteem and quality of life. Although dental health is so clearly tied to general health and well-being, it still fails to be covered by medical insurance, leaving one in three American adults without dental coverage.2 When considering the benefits of preventative dental care and the interconnectedness of oral and general health, some degree of integration of medical insurance and dental benefits would likely be beneficial to Americans’ overall health. So why are the two types of insurance separate, and how do healthcare providers feel about the impact of this separation on their patients’ health?

History of Dentistry

Dentistry is considered one of the oldest medical professions, with origins dating back to 7000 B.C.³ In the centuries to follow, dentistry began to separate itself from medicine. However, it was not until the 1700s that dentistry became an established profession.⁴ With the opening of independent dental schools and practices in the 1800s, dentistry became initiated as an entity separate from medicine.

As the field of dentistry evolved, its focus shifted from simply alleviating pain to adopting a holistic and preventative approach to patient care. Now, dentistry primarily focuses on preventative care, followed by diagnoses, treatment, and management of oral health issues. This cornerstone of the practice is reflected in the way dental insurance operates. 

Dental Insurance

Dental insurance was first introduced in California in 1954.⁵ Prior to the introduction of dental insurance, dentistry operated under a fee-for-service agreement. Now, plans are offered under a system of benefits with a focus on preventative care. Many people obtain dental insurance as part of a healthcare benefits package offered by their employer. In this case, the employer usually pays for much of the plan premium. Those who are not offered dental insurance by their employers will either seek it out privately or choose to forgo coverage.

Currently, dental insurance operates under a benefits system. Patients can receive treatments at a lower cost, up to a maximum annual value specified by the insurance company, by sharing expenses with the benefit carrier. Most dental plans have a maximum of $1,000 to $1,500 per year.⁶ Within this value, most preventative and restorative care, such as dental cleanings, oral hygiene checks, and cavity fillings, is fully covered. In addition to these services, procedures such as crowns and root canals are covered up to a certain amount, which is usually between 50-80%.⁶ However, if the cost of treatment within the timeframe of the patient’s plan exceeds the maximum plan value, the patient is subject to pay for the treatment themselves, which is termed an out-of-pocket payment. This is why dental insurance is sometimes referred to as “dental benefits” rather than “dental insurance.”

Patients with good oral health might use their dental plan only to get cleanings and exams a few times a year. Since these patients have no need for coverage of major procedures, they often lose money by paying for a dental plan since they do not take full advantage of the included services. Alternatively, patients with poor oral health or numerous dental issues tend to make full use of a dental care plan, but often face the risk of over-drafting their policy and incurring high out-of-pocket costs. For many of these patients, costs paid out-of-pocket can be greater than those covered by their plans. Due to this discrepancy, patients sometimes delay getting a dental problem treated until they either have the money to pay out-of-pocket or until their plan window resets and a fraction of the treatment cost will be covered.

Medical Insurance

Medical insurance operates in a very different manner. Employed people often receive medical insurance from their employer, while unemployed people can become eligible for state-funded aid. People holding private medical insurance plans pay their insurance companies a premium. An insurance premium is essentially a “membership fee” which many other people also pay to enroll in plans at the same insurance company. Because most people remain healthy, the insurance company can utilize the money they receive from these premiums to cover healthcare costs of those who become ill or injured. In other words, the insurance company absorbs a certain amount of risk upon providing plans for its enrollees. 

When an enrollee requires medical treatment, the insurance company will then cover some pre-established portion of the cost of their care. This portion can be anywhere between 60% to 90% of the medical bill, minus the enrollee’s deductible.⁷ A study conducted in 2020 found that “the average annual deductible for single, individual coverage is $4,364 and $8,439 for family coverage.”⁸ Unlike dentistry, medical insurance plans do not have an annual maximum, so patients do not have to worry about maxing out and paying entirely out-of-pocket. According to the United States Department of Health and Human Services, “insurance companies can no longer set yearly dollar limits on what they spend for your coverage.”⁹ Rather, they receive coverage regardless of the cost of treatment, and the patient portion is regulated by an out-of-pocket maximum. Table 1 summarizes the major differences between dental insurance and medical insurance.

Table 1: Dental Insurance vs. Medical Insurance

	Dental Insurance	Medical Insurance
Primary Treatment Type	Prevention	Treatment
Diagnostic Costs	Low	High
Effectiveness	High	Variable
Deductibles	Low	High
Out-of-Pocket Costs	High	Low

Why Isn’t Dental Care Included in Medical Insurance?

Oral health is linked to overall health because the mouth is the gateway to the rest of the body. Oral health and general physical health are not distinct components of human health, but are interrelated and interdependent. In fact, early signs of many major diseases can be identified in their early stages at the dentist, including heart disease, osteoporosis, and diabetes.¹⁰ Despite their shared connection, dentistry and medicine continue to operate separately, as do their respective insurances. 

More and more dentists and doctors are understanding the interconnectedness of oral health and general health and are consequently calling for a convergence of insurance. Practitioners in the field are not the only ones in favor of convergence: 93% of adults age 50+ want dental coverage included in Medicare.¹¹

Differing perspectives on the purpose of health insurance lead to different views on whether it should include dental care. Some may argue that the nature of medical insurance is what prevents it from encompassing dental benefits. According to this perspective, the purpose of medical insurance is to protect patients from financial ruin in the event of a catastrophic emergency. Dental care, especially preventative care, is thought to involve services which occur too frequently to be covered by medical insurance without raising premium costs. In fact, one of the reasons many people do not opt into dental care in the first place is because of high premiums. 

However, the cost of preventative treatment is minimal in comparison to that of general medical treatment, meaning that premiums would not increase significantly. Additionally, if medical insurance is only meant to save patients from bankruptcy, then many would argue that dental insurance should not be included within its bounds. But even though the cost of dental work is not as large as significant medical procedure costs, people can still take on a huge amount of debt for it—debt which would place a significant financial burden on many. Furthermore, if medical insurance is meant to provide equal access to medical services for all people, then preventative dental care must be included within medical insurance for it to be considered truly holistic.

In support of this holistic treatment, it seems that recent understanding among medical practitioners favors the body as an interconnected unit in which each system depends on the others. Medicine and dentistry are not as separated as they used to be, and oral health is beginning to become equally important as general health. Ninety-six percent of healthcare executives believe dental and health insurance are either already converging or soon will.¹¹ Under the Affordable Care Act, which increased insurance coverage in an attempt to reduce high healthcare costs for consumers, preventative dental care was made more accessible.¹² Thus, a different perspective on the purpose of health insurance was revealed: to provide patients with access to care at manageable costs. Under this motive, all health insurance should work to include preventative dental care. By bundling preventative dental care into a health insurance package, many oral health problems which could occur down the line can be prevented or identified in their early stages.

Health insurance claims to create a reality which gives patients equal access to care that keeps them healthy. If this is the full truth, then incorporating dentistry into health insurance in some capacity is the most obvious and fair path forward.  

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Disclaimer: The views and opinions outlined in this article are solely the author’s and do not reflect the views and opinions of AMWA Carolinas.

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About the Author

Sonia Gazula is a rising junior at Duke University pursuing a major in biology, with minors in chemistry and religion. Upon her graduation from Duke, she intends to study dentistry. She is interested in medical equity and holistic care. Her hobbies include cooking, crossword puzzles, and running.

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References

1. “Oral Health: A Window to Your Overall Health.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 Oct. 2021, https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475. Accessed June 2, 2022.
2. 2. “One-Third of U.S. Adults Went Without Dental Care, Even Before Pandemic.” UPI, UPI, 9 July 2021, https://www.upi.com/Health_News/2021/07/09/adults-dental-care/3261625837980/. Accessed June 14, 2022.
3. History of Dentistry. American Dental Education Association.https://www.adea.org/GoDental/Health_Professions_Advisors/History_of_Dentistry.asp. Accessed June 17, 2022.
4. Titor, J. History of Dentistry: From Barber-Surgeons to Dentists. History Daily. https://historydaily.org/history-dentistry-barber-surgeons-dentists. Accessed June 17, 2022.
5. MultiTrack Dental Benefits Industry History. Why Dental. https://www.whydental.org/about/history. Accessed June 17, 2022.
6. Understanding Dental Benefits. Why Dental. https://www.whydental.org/about/understanding-dental-benefits. Accessed June 17, 2022.
7. Why Health Insurance Is Important. HealthCare.gov. https://www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/.Accessed June 17, 2022.
8. Porretta, Anna. “How Much Does Individual Health Insurance Cost? .” EHealth, EHealth, 1 Oct. 2022, https://www.ehealthinsurance.com/resources/individual-and-family/how-much-does-individual-health-insurance-cost. 
9. Assistant Secretary for Public Affairs (ASPA). “Lifetime & Annual Limits.” HHS.gov, 15 Mar. 2022, https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/index.html. Accessed August 8, 2022.
10. Thinking About Oral Healthcare. Mouth Healthy. https://www.mouthhealthy.org/~/media/ADA/Publications/ADA%20News/Images/2017/November/20171117_MedicareInDental_OHAWakefield.jpg?la=en. Accessed July 27, 2022. 
11. Atchison, K. A., Weintraub, J. A., Rozier, G. Bridging the Dental-Medical Divide. Journal of the American Medical Dental Association. 2018;149(10):E850-858. https://jada.ada.org/article/S0002-8177(18)30361-1/references. Accessed July 5, 2022.
12. Vujicic, M. & Fosse, C. Time for Dental Care to Be Considered Essential in US Health Care Policy. AMA Journal of Ethics. 2022;24(1):E57-63. https://journalofethics.ama-assn.org/article/time-dental-care-be-considered-essential-us-health-care-policy/2022-01. Accessed July 27, 2022.