56% of survey respondents don’t have dental coverage. Here’s why.

In our most recent reader survey, we asked our readers whether they have dental coverage. The majority of our respondents – who indicated they have Medicare coverage – answered that they don’t currently have dental coverage. But about 44% of our respondents do have dental coverage, from a variety of sources.

Here’s how the responses stacked up:

• 56.5% – No. I do not currently have dental coverage.
• 16.2% – Yes. I have dental insurance through a Medicare Advantage plan or as a dual-eligible (Medicare plus Medicaid).
• 15.2% – Yes. I have dental insurance through an employer-sponsored health plan (my own or a family member’s).
• 12.1% – Yes. I have stand-alone dental insurance.

Why the majority don’t have dental coverage

While it’s not surprising that the largest response category was people who don’t have dental insurance, we would have expected to see a larger percentage of our respondents with dental coverage under a Medicare Advantage plan, especially since we included Medicaid dental in that same response category.

The vast majority of Medicare Advantage plans provide dental coverage, and more than 43% of all Medicare beneficiaries are enrolled in Medicare Advantage plans. But our respondents may have included a disproportionate number of Original Medicare beneficiaries.

Among our respondents, those who indicated that they do have dental coverage were fairly evenly split between employer-sponsored dental coverage, privately purchased stand-alone coverage, and Medicare Advantage or Medicaid. Nationwide, a total of about 16% of Medicare beneficiaries have dental coverage from a stand-alone individual plan or an employer-sponsored plan.

So our survey respondents are more likely to have these plans than the average Medicare beneficiary.

A lack of dental coverage is common for Medicare beneficiaries

Nationwide, 47% of all Medicare beneficiaries had no dental coverage as of 2019. About a quarter of all Americans have no dental coverage, so Medicare beneficiaries are more likely to be without dental coverage than the general population.

This makes sense when we consider that employer-sponsored health insurance – which is by far the most common source of coverage in the United States – usually comes with supplemental dental coverage. And thanks to the Affordable Care Act, most American children have dental coverage even if their health insurance isn’t provided by a parent’s employer. (Pediatric dental coverage is available or included when families buy their own health coverage, and Medicaid/CHIP (which covers 39 million American children) is required to include dental coverage.)

But things are different for Medicare beneficiaries. Although most Medicare Advantage plans do include at least some dental coverage, Original Medicare – which covers the majority of Medicare beneficiaries – does not cover dental care unless it’s a service that’s necessary in conjunction with a treatment that is covered by Medicare (for example, jaw reconstruction after removal of a tumor).

Out-of-pocket costs significant, even with dental coverage

In addition to the survey responses, some readers responded with commentary on social media. For those who have needed significant dental work, a common theme was that their dental coverage – regardless of the source – hasn’t been comprehensive enough.

One described their coverage as “limited” and pointed out that it doesn’t cover the dental work they need. Another focused on the sky-high cost of dental implants, and the fact that their Medicare Advantage dental plan wouldn’t cover them at all.

A recent KFF analysis found that Medicare Advantage enrollees have average out-of-pocket dental spending that’s nearly as high as Original Medicare beneficiaries’ dental spending. And out-of-pocket dental costs can be quite high with employer-sponsored and stand-alone dental plans as well, especially if a person needs extensive dental work.

This is because most of these plans – including Medicare Advantage dental, employer-sponsored dental, and self-purchased dental plans – generally have fairly low benefit caps. It’s common to see annual benefit caps of $1,500 or less. Although the cost of dental care has increased over time, these limits have been fairly static for decades.

Although the Affordable Care Act ensures that most medical insurance plans no longer have dollar limits on essential health benefits, adult dental care is not considered an essential health benefit. Pediatric dental is, which means that children no longer face annual or lifetime benefit limits when they need dental care. But the same is not true for adults.

So while medical plans can generally be counted on to step in to alleviate high costs – both the expected and the unexpected – the same cannot be said of dental plans. Although there are some exceptions, most dental plans tend to cover preventive care and low to modest expenses, while leaving patients on the hook for substantial costs if they need expensive dental work like implants.

Medicare might include dental coverage as of 2028

Consumer advocates and some lawmakers have long pushed to add dental coverage to Medicare. And the Build Back Better Act, which is currently under consideration in Congress, includes provisions that would add dental, vision, and hearing benefits to Medicare Part B.

But the dental benefit is expected to be the most costly, and the legislation clarifies that it wouldn’t be available to beneficiaries until 2028. The specifics are still up for debate in terms of what would be covered and how much beneficiaries would pay in out-of-pocket costs. But if the legislation is successful and ultimately includes the proposed dental, vision, and hearing coverage for Medicare, it would be the most significant enhancement of Medicare benefits since Part D was added in 2006.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.