Proposal to Expand Adult Dental Care Announced

Proposal to Expand Adult Dental Care Announced

A new regulation made by the Biden administration, under the Affordable Care Act, seeks to include adult dental care as a benefit health insurance may cover. The proposal allows states to include dental care as an “essential health benefit” (EHB) without annual limits on members. States would not be required to include these benefits, but a reversal on the ban of including adult dental services as essential benefits would occur. At least one dental coverage option is offered in every state. Coverage would be offered under medical coverage or as a standalone plan under the proposal.  

According to the CareQuest Institute for Oral Health, an estimated 68.5 million U.S. adults did not have dental insurance in 2023. Concurrently, according to the Centers for Disease Control and Prevention, more than $45 billion was in lost productivity due to untreated dental disease. These untreated diseases have been additionally linked to health problems including heart disease and diabetes.

Importance of Oral Health

While the coverage of oral health is debated, it is important to have good oral health. Here are general facts to know:

  • Oral health impacts general health including diabetes, heart disease, and high blood pressure;
  • Disease caused by oral pain and infections can be a leading cause to difficulty eating and speaking;
  • Cavities, severe gum disease, and severe tooth loss are three of the most common oral conditions;
  • 1 in 4 adults aged 20 to 64 have cavities; and
  • Two risk factors for gum disease are tobacco use and diabetes.

 

States have until May 2025 to decide on the addition of dental care to ACA benchmark plans. These benefits would not be effective until the 2027 plan year.

It is important to have good oral health as it is preventative for future risks and costly care. If you have questions regarding your dental insurance contact your dedicated Creative Benefits, Inc. ESR team.