With the economic crisis, job loss, and resulting financial burdens Americans face today, dental care and insurance is being impacted in dramatic ways for all age groups. Furthermore, the government budget changes may severely reduce dental care to children. Even with the dental insurance available now, children are not receiving adequate care. Unfortunately, low income families are worse off than anyone involved.
Low Income Insurance
Currently, there are two primary health care plans that include dental coverage. Below is a comparison of the difference between Medicare and Medicaid.
Although not based on income, which is a huge benefit for those with low income levels, this program only covers those aged 65 or older and younger persons with disabilities or specific conditions. Premiums are required for Medicare Part B services, which include durable medical equipment. The Federal Government works in conjunction with subcontractors who act as fiscal intermediaries and make decisions for DME and prosthetic devices.
There is a higher requirement for documentation during the application and service process but claims are filed post-delivery or charge. Payments are made to the beneficiary or manufacturer/supplier with a requirement for co-payments by the beneficiaries in most cases. The administrative procedure takes five steps and judicial reviews are available in federal court.
Unlike Medicare, this program is income based. However, all ages are eligible and most individuals will not be required to pay a monthly premium (although in certain cases, participants have a “spend down” requirement on a monthly basis for eligibility). Medicaid is often used by low income families because it covers all members of the family, regardless of age. Administration is done by State Governments who are subject to federal regulations and guidelines.
Because Medicaid functions with state-level oversight, less documentation is required to process services. Claims are also filed prior to delivery or charge and payments are only made to the manufacturer or supplier. In most states co-payments are not required, but in the instance that they are required, co-payments must be minimal. The administrative process is vastly simpler than that of Medicare — only one or two steps are required for the process. Judicial review is available in state or federal court.
In addition to the coverage offered by Medicaid and Medicare, some states and other local organizations have begun to offer limited free dental.
The Gazette reports that His Hands Free Medical Clinic in Iowa, which is offering free services to the uninsured and underinsured, has a waiting list already, though the grand opening isn’t until Thursday. The office is staffed by eight volunteer dentists but regular hours have yet to be established. His Hands Free Medical Clinic attends to both adults and children who may not qualify for other services. The clinic recently received a $100,000 donation from Physicians’ Clinic of Iowa that helped it open earlier than anticipated. Tax incentives also helped finance the medical pavilion.
Certain clinics have designated Free Dentistry Days where they perform fillings or extractions at no cost, like the Willow Knolls Family Dental in Peoria, Illinois. According to pjstar.com, it has scheduled its free service day for May 18th but appointments can’t be made in advance — patients will be accepted on a first come, first serve basis.
HealthNet of Rock County Inc. started in 1994 as a completely free clinic serving all those without health insurance. It provides aid for all medical needs, not just dental. In 2010, HealthNet reached full capacity and had to reduce the number of new enrollments to five patients a week, down from 30 to 40 weekly. The majority of their funding comes from donated services and materials, followed by grants, contributions, and fundraising.
Despite the government increasing availability of health care, the quality of the care is decreasing. Many children — especially those in low income families — are receiving inadequate care or none at all. The Agency for Healthcare Research and Quality conducted a study of the effectiveness of care relative to the availability and found that poor and near-poor children were 50% less likely to have received preventative care than those in higher income families. In several states, their studies revealed that a mere 31% of children insured by Medicaid actually received preventive care.
Part of the problem with Medicaid-insured children is that many dentists and doctors don’t accept Medicaid. In response to this issue, President Barack Obama recently announced a pay raise for primary doctors tending to children insured by government programs. So far, there has been no confirmed indication that dentists will be included in this incentive drive.
Regardless of what the government intends to do about the problem of children not being given adequate dental care, private organizations are increasing efforts to provide additional care to uninsured children and adults. Even if cuts were made to both Medicare and Medicaid, or if the programs were completely abolished, Good Samaritan clinics would still rise to the occasion and provide free or affordable solutions for dental care to all ages.