by Lynn Doan, Strategic Engagement Fellow
For the first 21 years of my life, I did not have dental insurance. I just paid out-of-pocket costs whenever I needed care. For me, this wasn’t an issue because I took care of my teeth and thankfully didn’t have many problems. I always assumed, however, that if a problem ever did arise, getting the information on how to get dental insurance would be as simple as asking my dentist.
That was not the case. The other week, I approached my dentist about shopping for dental coverage and was surprised when he wasn’t clear on what options were available to me. He recommended one external insurer but knew very little else. If I chose not to enroll through that insurer or in his family plan, my only option was to pay out-of-pocket for my appointment.
Our interaction made me realize both how beneficial the Health Insurance Marketplaces, like Connect for Health Colorado is for people like me, and how many people are unaware of those benefits. The marketplace provides consumers with a platform to compare prices and shop for health insurance, including dental insurance, and is only open during the enrollment period (Nov. 15, 2014 – Feb. 15, 2015).
In Colorado, everyone must purchase pediatric dental coverage, even adults without children, when they purchase health insurance. However, there are $0 or low-cost plans available to meet this requirement. You have to attest when you buy it. Adults are not required to have adult dental coverage, but some health plans will offer dental products for adults.
Nationally, nearly 7.3 million people have bought health insurance through marketplaces so far this year. Yet, the National Association of Dental Plans states that 126.7 million Americans nationwide still do not have dental coverage. Those without dental insurance are more likely to ignore dental problems instead of seeking care due to the steep out-of-pocket treatment costs. At the same time, they are reported to more likely have extractions, dentures, and higher incidences of other illnesses.
A lack of dental insurance and poor oral health extends beyond your mouth. Studies have shown that those without dental coverage are 67 percent more likely to have heart disease and 50 percent more likely to have osteoporosis.
Connect for Health Colorado is a useful tool to access dental insurance and combat these statistics. Although the marketplaces opened around the country over a year ago, it’s still unfamiliar territory for many. Connect for Health Colorado offers dental coverage in one of two ways: as a part of a medical plan (embedded in a health insurance plan) or through a separate dental plan (stand alone plan).
There are important differences between the two types of plans. For instance, stand alone plans have a separate, and generally lower, deductible and out-of-pocket max than the medical deductibles. Embedded plans have a shared deductible and out-of-pocket max for both medical and dental services. A one-page overview of these differences can be found here.
When purchasing a dental plan, consumers should think about how much dental care their family might need compared to medical care and the difference in costs. The differences in stand alone plans and embedded plans are significant and the wrong purchase can even prevent you from accessing your care. By not understanding if your plan has a single deductible or a shared deductible, your dental care may be subject to high deductibles – resulting in you not being able to actually receive all the benefits right away.
For instance if your children need expensive dental care but are otherwise healthy, you might want to buy a stand alone dental plan. That way, your children will have access to more robust dental benefits due to the lower deductible. Families who choose an embedded plan might need to pay a significant amount of out-of-pocket costs in order to reach a higher deductible, before their insurance would begin to cover dental costs.
However, if your family needs ongoing or significant medical care, an embedded dental plan would be a great option. That way, all of your spending counts towards the shared deductible and out-of-pocket-maximum. Your insurance will start paying the full cost of both medical and dental care sooner. This decision-making tool is a great resource to help consumers decide on which plan is best for their family.
The mouth is part of the rest of the body when it comes to overall health. Like health insurance, everyone should have barrier-free access to dental coverage. Improvements in the new insurance landscape won’t make a difference if consumers are unfamiliar with their options. To learn more about dental plan options, visit Connect for Health Colorado. To learn more about current oral health information in Colorado, visit Oral Health Colorado.