Although your health insurance plan should cover medical emergencies, it’s unlikely it will cover a dental emergency, even if it's provided in a hospital. Health insurance programs treat dental coverage as an option, entirely separate from the rest of the policy, with different deductibles, co-payments, and maximums. Contemporary health reform programs don't change this for adults.
If you’re faced with a dental emergency from an accident, you may be covered with a secondary plan. If if happened in the workplace, for instance, you may be eligible for coverage from the employer’s liability or workers’ compensation insurance. Likewise, when a dental injury results from an automobile accident, the treatment is usually covered by the medical coverage portion of your auto insurance, or that of the driver responsible for the accident.
Medicaid and Medicare
According to an American Dental Association research brief issued in 2013, 42 of the 50 states offered dental services to adult Medicaid enrollees. Sixteen only had it for emergency services, which is usually limited to relief of infection and pain. Of the remainder, 15 had limited services beyond emergency treatment, and only 11 offered an extensive program of dental benefits. On the other hand, children on Medicaid nationwide receive a comprehensive dental coverage program. Traditional Medicare likewise offers no dental coverage, although some Medicare Advantage programs have dental riders.
TMD Joint and CMD Disorders
Many states require health insurance plans to cover treatment of the jaws, the jaw joint, and the muscles controlling them. These problems, even when treated by a dentist, may be included in your health insurance. If that's the case, it doesn't matter if you have dental coverage or not.
Covering the Pain
Beyond pain management, hospital emergency rooms generally don’t have the equipment or the staff to handle dental emergencies. Thus, if you visit a hospital emergency room to be treated for a dental emergency, you’ll probably be treated only for the pain. A bright spot is most health insurance plans will cover emergency room treatment for dental pain in accordance with their emergency room rules, which generally involve a significant copay if the visit doesn't lead to an admission.
The Patient Protection and Affordable Care Act
The PPACA of 2010 created numerous changes in the way health insurance was packaged and marketed, but it didn’t address the practice of treating dental pain without treating the underlying disorder. It also didn’t require an adult's health insurance include dental coverage, but did call it an "essential benefit" for children. Studies that projected increases in dental coverage due to the PPACA showed these increases are nearly all in Medicaid, and then only in those states that expanded their Medicaid coverage under a provision of the PPACA.
- Nonprofit Quarterly: Dental Weaknesses In ACA Healthcare Insurance Coverage
- Lack of Dental Coverage Sends Patients to ER for Pain
- Fair Health Consumer: Emergency Care vs. Urgent Care
- American Dental Association: TM Treatment and Third Party Insurance Coverage
- Medicaid.gov: Dental Care
- American Dental Association Health Policy Resources Center Research Brief: Affordable Care Act Expands Dental Benefits for Children But Does Not Address Critical Access to Dental Care Issues
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