Dental Plans: Why Americans Are Paying More For Less


The American Dental Association (ADA) says three economic forces are creating the "perfect storm" that is reducing the number of U.S. families with any dental coverage. The ADA, which has more than 157,000 members, published a report in April, "Breaking Down Barriers to Oral health for All Americans: The Role of Finance."

The first out of the three economic forces is unemployment, namely the 12.7 million Americans without jobs who have lost their private insurance coverage.

The second is a "steady reduction" in the percentage of firms providing dental benefits. The ADA says about half of companies offering health benefits also offer dental. But fewer companies are offering health benefits.

The third force, according to the ADA, is that firms are shifting costs to consumers to pay out of pocket. Because of the economic downturn, employers are reducing the scope of coverage or increasing the amount workers pay for third-party private benefits, the Kaiser Family Foundation and the Health Research and Educational Trust reported in a 2010 survey.

From 2000 and 2010 the general CPI increased 127 percent. Meanwhile, the consumer price index for dental services rose 154 percent over that period - twice as fast as rate of inflation in the last decade, according to the Bureau of Labor Statistics.

In 2008, total dental expenditures accounted for $30.7 billion or 22.2 percent of total out-of-pocket health expenditures, second only to prescription medications, according to a report by Glassman.

One recent movement in health care payments reform that focuses on health outcomes as opposed to the number of visits or procedures is beginning to gain traction in dental care, Glassman said. The idea behind that reform is moving to a value system, instead of a volume system.

That movement may address the rising out-of-pocket costs for dental patients.

"Dental care is almost entirely volume-based and people are looking to how you can make it value-based."

One of the barriers to this system is that dental care is divided among many large private insurers and dental practices are without the capacity, funds and political will "to establish meaningful quality improvement programs," according to Glassman.

About 50 percent of the population has private insurance, Glassman reports.

Edelstein said under current and proposed legislation, states and the federal government can develop plans to provide more intensive dental care to those with greater needs and less to those who don't need it.

"This would be a meaningful and new advancement in dental coverage that would better align benefits with needs and replace the "one size fits all twice a year checkup" design that now predominates," Edelstein said.

Whether you have an employer subsidized dental plan, there are some steps you can take to make sure you are getting the most affordable dental care you can:

1. Many experts suggest seeking low-cost dental care, such as through Federally Qualified Health Centers.

Sanders' bill proposes increasing funding for oral health services at these public clinics, which have a sliding pay scale, and for school-based dental services. He also proposes new funding for mobile and portable services.

Glassman is also a proponent of telehealth services in which dentists could provide remote supervision and collaboration without seeing every patient in person.

2. Put money in a health savings account (HSA).

Nancy Metcalf of Consumer Reports said she often discourages people who do not have subsidized dental plans from getting individual dental coverage.

"You're probably better off if you have a HSA [health care spending account] by tucking money in there," she said.

Consumer Reports readers who are insured said the average cost of a filling was $141. For those who were uninsured the average cost was $288. The average cost of a tooth implant for an insured person was $2,825, while those who were not insured was $3,938.

3. Research and negotiate prices.

Metcalf said allows people to look up prevailing prices for local services.

"Call up the dentist and make a deal with them," she said. "Say that you'll go to them for a root canal for $1,000. You're probably going to do just as well if you don't have dental insurance."

ABC News' Alan Farnham contributed to this report.

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