The Biden administration wants to make it easier for Americans to get dental care. But don’t try to book an appointment just yet.
a new rule out this month Allows states to include adult dental care as a benefit that health insurers must cover under the Affordable Care Act. next Record ACA enrollment this yearThe proposal represents an election-year aspiration for the future of Obamacare: It doesn’t require states to do anything, even if it pretends to. President Bidenis intended to make the ACA a more robust safety net.
“This is huge, really important,” said Colin Reuschpolicy director community catalyst, a health coverage advocacy group. He said the new Biden administration rule represents “one of the first real changes” to the law’s coverage provisions since it was passed in 2010.
But like health care, expanding access to dental services is more complicated than it seems.
an estimated 68.5 million US adults could lack dental insurance in 2023, according to nonprofit CareQuest Institute for Oral Health, it’s more than that 2.5 times Roughly speaking 26 million Americans of all ages those who lack health insurance,
And millions of Americans lost dental coverage last year as part of Medicaid “unwinding,” which left out low-income people who had been covered by the program during the pandemic.
At the same time, Untreated dental disease is estimated to cause huge losses to the United States more than $45 billion According to, the annual productivity has decreased Centers for Disease Control and PreventionAnd it’s linked to a long list of even more serious health problems, including heart disease and diabetes.
Nevertheless, efforts to expand US dental coverage have long resulted in cost reductions. When people have dental insurance, they use it. Therefore adding coverage to a health insurance policy may increase the total premium.
This is why traditional Medicare coverage explicitly excludes most dental care. (Many private Medicare Advantage plans offer some dental coverage as an inducement for seniors to join.)
An effort to add dental benefits to Medicare stripped naked From Biden’s “Build Back Better” legislation before it is passed as the Inflation Reduction Act in 2022. Instead, the administration Clarified and expanded limited circumstances Wherein Medicare may cover dental care. Any progress on oral health — including giving states the option to require coverage for adults — is seen as a victory by advocates. Dental coverage for children is already an essential benefit under the ACA.
But whether they actually get coverage depends on states affirmatively adding dental benefits to benchmark plans in the ACA’s insurance marketplaces., Those plans not only determine which services Affordable Care Act insurance has to cover, but also set parameters for state-employee and many private-employer health plans.
Reusch said some states are considering changes, but it will take some time before anything is confirmed. States have until May 2025 to decide whether to add dental care to benchmark ACA plans; The benefits will not take effect until the 2027 plan year.
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