Policy Examples

• Dental coverage is not mandated by the ACA in exchange plans for adults. Individuals and small groups can contract directly with dental insurance companies to arrange benefits. source
• Medicare does not cover most dental care,  procedures, or supplies. Medicare Part A will pay for certain dental services that are obtained in a hospital setting. source
• Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state. source
• States are not required to provide adult Medicaid beneficiaries with dental care. However, most states provide emergency dental services for adults in Medicaid, while less than half of states currently provide comprehensive dental care. source

Outcome Evidence

• According to a 2016 survey by Lincoln Financial Group, one-in-four consumers with dental coverage had not been to the dentist in the prior year, citing high costs. source
• General Dentistry and American Family Physician collaborated on a document that explains the vitality of good oral hygiene and its relationship to overall physical health. The U.S. Surgeon General is releasing a paper on oral health in 2020. source & source
• According to the 2019 Kaiser Family Foundation employer survey, among firms offering health benefits in 2019, 59% of small firms and 92% of large firms offer a dental insurance program to their workers separate from any plan included in their plan. 63% of firms offering a dental program to their workers make a contribution toward the cost of the coverage. source
• A 2014 survey published by TruAssure found consumers are generally aware of the link between dental health and overall health, however, there is room for further education. source
• A 2017 article from Health Affairs concluded that Medicaid expansion under the Affordable Care Act (ACA) has subsequently increased dental coverage, but alone is not enough to improve access to dental care among low-income nonelderly adults. source