Obamacare is not good for teeth

 

Obamacare is a boon for boomers in several ways. Dental coverage, alas, is not one of them.

More Americans lack dental care than health insurance, and while dental bills rarely reach the stratospheric heights of medical bills, they can still take a big bite out of retiree savings. However, while the Affordable Care Act has created a new way to shop for dental insurance, it has not improved the quality of that coverage, nor has it managed to make the economics any friendlier, at least not for adults.

For the most part, Medicare does not cover dental care; the program pays only in certain cases where dental and medical needs intersect. And only 2% of retirees have dental coverage through a previous employer, according to Oral Health America, a Chicago-based nonprofit that works on dental access and education issues. Nationwide, 126.7 million Americans lack dental coverage, nearly three times the number medically uninsured, according to the National Association of Dental Plans.

The stakes for this coverage gap are high when it comes to your health and your wallet. Not only are dental problems expensive and painful in their own right, but inadequate dental care can negatively impact your health.

When the healthcare screen.gov shows, chances are the patient is confused. The Affordable Care Act health care exchanges have not offered much help for adults who lack dental coverage.

To give just a few examples: Diabetes can contribute to gum disease, which in turn can aggravate diabetes. Studies have also suggested a link between gum disease and increased risk of stroke. Weak teeth can make it harder to eat a nutritious diet, which worsens overall health, said Dr. Charles Norman, president of the American Dental Association.

Even those with dental insurance will find themselves on the hook for a potentially large share of the bill if their needs are more-than-routine. The typical dental plan-bot through an employer or on the individual market-pays between $1.000 and $2.000 annual benefits per patient. That might be for the young and cavity-free order, but it doesn't go that far when you have a whole range of dentures on more than $3.000 or a gulp of implants at $4.000 per tooth need.

In this respect, dental care is different from medical care. The Affordable Care Act, informally known as Obamacare imposed annual caps on patients' out-of-pocket medical costs in their plan network. So far, some plans in the individual insurance market have brought no spending limits at all leaving patients vulnerable to financial ruin in the face of a devastating disease.

What's more, banned care discrimination based on health status. People with pre-existing conditions (and it's the rare boomer who doesn't have at least one) no longer on the individual insurance market are charged for health insurance or denied coverage altogether.

However, with most dental plans, the tooth you lost before you enrolled is your problem; the plan typically won't cover anything related to that missing tooth.

Why tooth is different

So why is Care toothless when it comes to adult dental benefits? The law called pediatric dental benefits one of 10 essential health benefits that starts this year must be included in certain health plans. The law imposes annual out-of-pocket caps on certain pediatric dental costs, limiting families' financial risk.

But these benefits do not extend to adult dental. Medicare does not cover routine dental care, and "that inertia spilled over into the ACA," said Dr. David Krol, senior program officer at the Robert Wood Johnson Foundation, a philanthropy dedicated to health and health care.

A Visitor HealthCare.gov-the care portal for residents of 36 states-may think that caps on adult dental care apply to patients expenses are awarded. Stand-alone dental plan descriptions on the window shopping section of the website list the limits for out-of-pocket expenses that apply to pediatric coverage (referred to as "out-of-pocket maximum"). But in general, the description does not show these limits apply only to children. This makes the plans look much more generous than they really are for adults.

To get a full plan details, while window shopping, including annual benefit limits for adults, you need to check out healthcare.gov click to see each insurance company's own plan brochure.

The picture becomes clearer for registered users of healthcare.gov, which uses the "compare plan" feature for dental coverage-these descriptions note the out-of-pocket maximums apply only to benefits basic health child. But it's a step that some shoppers don't take advantage of.

It's misleading that adult benefit caps aren't shown earlier in the shopping process, said Jonathan Wu, CEO of Valuepenguin.com, a consumer finance website with analysis on health care, car insurance and other topics. It's easy to get a boomer needing a root canal on mol (at a national average of $919, excluding the final crown, according to the American Dental Association) or a porcelain crown ($1.026), browse the site, imagine, and thought he had discovered a much better alternative than previously existed.

A spokesman for the Centers for Medicare and Medicaid Services, which is responsible for the site, said the information that must now provide plans is much clearer and standardized than it was before the law.

No a la carte options

Consumers seek dental help on healthcare.gov can also find another source of frustration: only consumers who have purchased stand-alone dental plans shown on the website, who have purchased health insurance on the website can purchase them. In other words, on healthcare.gov those who receive health but do not have dental insurance through their employers a very large group do not want to be able to purchase dental only. (A very small number of health plans on healthcare.gov-less than 1%, according to an analysis by Valuepenguin.com offering adult dental benefits under the plan.)

Approaches differ among states that run their own exchanges. For example, Colorado, Connecticut, Vermont and Maryland allow consumers to purchase only a dental plan and not a medical plan; New York offers dental plans for adults who have purchased on the medical market; while Covered California currently has no stand-alone adult dental offerings.

In any case, that federal subsidies help income-eligible consumers pay for their health insurance can't be used on adult dental care.

Because of its limitations, it is best to think of dental care generally as pay-as-you-go (or prepaid) benefit as opposed to "insurance," said Dr. Steven Bornfeld, a Brooklyn, NY dentist in private practice with his twin brother Mark. We generally purchase insurance to protect us against unexpected and catastrophic. Dental plans, on the other hand, cover the routine and expected: regular cleanings, cavities and the like. "If you really, really need it, it covers less," Bornfeld said.

Plans typically cover preventive services like routine cleanings at 100% and then cover major expenses like crowns or implants at a lower rate until you hit the annual benefit cap. Patients sometimes needed care over a period of staggering years to stay within their annual limit, Bornfeld said.

A financial plan for the teeth

Whether you have dental coverage or not, it's important to budget for oral health expenses as you get older, experts say. Dana Anspach, a financial planner in Scottsdale, Ariz., Says she charges all her new customers for a budget of their expenses. "At 18, I never saw tooth as a position," , said Anspach, who is also a Market RetireMentor columnist . (Read 3 Precautionary questions for the second marriage .)

Some of benefit might be setting up a dedicated savings account just for dental expenses so they aren't tempted to use the money for something else, Anspach said. Even if a dental need, a special pot of money with means that people may be more likely to seek immediate care. Consider allocating around $100 per month toward future dental costs, Anspach said.

If you have a health savings account, a tax-advantaged savings account available to certain consumers enrolled in high deductible health plans, you can use it to fund dental expenses, a strategy Anspach used himself. It also pays $17 per month part of a regional dental group. It's not insurance, but a type of membership plan that gives their discounts on treatments within the group.

Many boomers seek great dental care abroad, where the cost can run much less. Mexico and Costa Rica are two popular destinations, according to patients Beyond Borders, publisher of consumer and reference information on medical tourism. Josef Woodman, CEO of Patients Beyond Borders, said that a patient who has $60.000 for a bite of implants in the U.S. was $17.000 for the same work in Costa Rica was cited.

Those who would rather stay closer to home can seek diskon treatment at dental schools and other clinics. Each institution sets its own admission criteria, and often there is a waiting period involved, but most places "bend over backwards" to accommodate people, said Beth Truett, president of Oral Health America.

Low-income adults on Medicaid can receive dental benefits; the program is administered at the state level, and the extent of adult dental benefits varies widely from state to state, Truett said. Oral Health America runs a website with an interactive map to toothwisdom.org/care , which helps older adults across the country find affordable dental care near them.

People often are of their dental needs out of the blue, but they shouldn't be, Anspach said. This is especially true since boomers will be one of the first generations to age out with all or most of their original teeth, experts say. Just like older bodies, older teeth will require maintenance. "It shouldn't be unexpected," Anspach said, "It should be," I have the teeth, and they will need care over the years. "