By Donna Domino, features editor

October 9, 2015 -- Dental care is the most common healthcare need that many insured adults cannot afford, according to a September 24 report from the Urban Institute's Health Policy Center. Some 20% of adults with health insurance say they cannot pay for dental care.

Authors Adele Shartzer, MPH, PhD, and Genevieve Kenney, PhD, used data from the institute's March 2015 Health Reform Monitoring Survey (HRMS) to examine the unmet need for dental care due to affordability. They focused on adults ages 18 to 64 who were insured for the previous 12 months.

Top unmet healthcare needs among insured adults
Unmet need Percentage
Dental care 20.1
Prescription drugs 13.3
Medical follow-up tests 11.0
Medical care 10.4
Physician care 10.3
Specialist care 9.6
Mental health/substance abuse 5.6
Contraception 2.0
Source: Urban Institute's Health Policy Center

Among those with any unmet need due to cost, 71.4% said this included dental care, and 28.9% cited dental care as their only unmet medical need, the authors found. Overall, 28.2% of adults reported unmet medical needs due to cost.

The September 24 article is part of a "QuickTake" series that pulls data from the HRMS, a quarterly survey of approximately 7,500 nonelderly adults.

Coverage not enough

Affordable dental care was particularly challenging for low-income adults with insurance coverage: Nearly one-third (30.8%) reported an unmet need for dental care because of cost.

However, affordability issues were common among insured adults with higher incomes as well. Some 23.8% of adults with family incomes between 139% and 399% of the federal poverty level (FPL) and 11.4% of adults with family incomes at or above 400% of FPL reported an unmet need for dental care due to cost.

Insured adults who identified as Hispanic were more likely to report an unmet need for dental care because of affordability (24%, compared with18.8% of Caucasians), and women were more likely than men to have unmet dental needs (22.4% of women, compared with 17.7% of men), according to the authors.

“Dental benefits can be an important factor to attract and retain workers.”
— Anthony Wright, executive director of Health Access California

Although many employers offer dental coverage through separate insurance plans, fewer employees have access to dental coverage (45%) than health coverage (70%) through work, according to a Bureau of Labor Statistics study, Shartzer and Kenney wrote.

Jeff Album, vice president of public affairs for Delta Dental, said dental benefits are one of the first things new employees inquire about.

"Relative to medical benefits, the value proposition for group-sponsored dental benefits is only increasing over time as a means for small and large companies alike to attract and retain talent," Album told "There is a growing appreciation for the role oral health plays in overall health, and dental remains the second most highly requested benefit in most employee surveys."

Because dental benefits are often unaffordable, they can be a valuable consideration for employees, noted Anthony Wright, executive director of Health Access California.

"Dental benefits can be an important factor to attract and retain workers," Wright told "It's one of the most common questions I get about the [U.S. Patient Protection and Affordable Care Act (ACA)]: 'Does it include dental?' It sends a signal that the employer cares about their workforce and wants them to not just be healthy, but also without dental problems. If workers feel valued, and they have a good benefits package, they're more likely to stay, and that reduces turnover, training, and recruitment costs."


The challenge of affording dental care even for those with health insurance is consistent with patterns before the ACA took effect in 2014, the report notes.

The ACA has expanded access to insurance coverage for millions of adults, and it has improved coverage for preventive services, but financial barriers to dental services are still largely unchanged, the authors pointed out. Medicaid's "benchmark benefits" for newly eligible people include oral health coverage for children but not for adults, and the list of essential health benefits that must be covered by qualified private health plans does not include dental benefits.

"Though the ACA has led to increased health insurance coverage for millions of nonelderly adults, and early signs indicate improvements in broad measures of access to care and affordability, we find that gaps in access to dental care remain even for insured adults and that low- and moderate-income adults in particular face challenges affording dental care," they concluded.

Copyright © 2015

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