The Biden administration wants to make it easier for Americans to get dental care. But don鈥檛 try booking an appointment just yet.
A new regulation allows states to include adult dental care as a benefit that health insurers must cover under the Affordable Care Act. Following , the proposal represents an election-year aspiration for the future of Obamacare: It doesn鈥檛 require states to do anything, even as it shows off President Biden鈥檚 intention to make the ACA a more robust safety net.
鈥淚t鈥檚 huge, really significant,鈥 said Colin Reusch, director of policy at Community Catalyst, a health coverage advocacy group. He said the new Biden administration rule represents 鈥渙ne of the first real changes鈥 to coverage provisions of the law since it passed in 2010.
But like so much in health care, expanding access to dental services is a lot more complicated than it sounds.
An estimated 68.5 million U.S. adults lacked dental insurance in 2023, according to the nonprofit CareQuest Institute for Oral Health. That鈥檚 more than 2.5 times the roughly 26 million Americans of all ages .
And millions of Americans lost dental coverage in the past year as part of the Medicaid 鈥渦nwinding鈥 that dropped low-income people who had been covered by the program during the pandemic.
At the same time,聽聽more than聽$45 billion聽in lost productivity annually, according to the聽Centers for Disease Control and Prevention, and it鈥檚 linked to a long list of even more serious health problems, including heart disease and diabetes.
Still, efforts to expand U.S. dental coverage have long foundered on the shoals of cost. When people have dental insurance, they tend to use it. So including the coverage in a health insurance policy can raise overall premiums.
That鈥檚 one reason traditional Medicare coverage explicitly excludes most dental care. (Many private Medicare Advantage plans offer some dental coverage as an enticement for seniors to join.)
An effort to add a dental benefit to Medicare was stripped from Biden鈥檚 鈥淏uild Back Better鈥 legislation before it was passed in 2022 as the Inflation Reduction Act. Instead, the administration in which Medicare can cover dental care. Any progress on oral health 鈥 including giving states the option to require coverage for adults 鈥 is seen by advocates as a victory. 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鈥檚 insurance marketplaces. Those plans not only determine what services Affordable Care Act insurance has to cover, but also set parameters for state-employee and many private-employer health plans.
Reusch said a few states are considering the change, but it will be a while until anything is certain. States have until May 2025 to decide whether to add dental care to benchmark ACA plans; the benefit wouldn鈥檛 be effective until the 2027 plan year.
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