Insurance and Taxes make barriers to Dental Healthcare. But We’re Not Giving Up!

Dental Health Insurance: Joke’s on You

U.S. Health Insurance companies mostly exist in their current form to make profit off of us–this we already know. It’s business. The way these companies make profit is that they rely on the probability that among all the people who pay into a health insurance plan, a  large amount of those people will not get very sick and will not need extensive coverage. Based on that probability game, that the health insurance companies pocket gross profits. They rarely (I said rarely, that doesn’t mean never…) care about your health or mine, outside of how they profit from us.

As a dentist, it’s especially sad to say that dental health insurance is often at the bottom of the barrel. Dental health insurance is horrible and *if* dental insurance even exists on someone’s health insurance plan, the coverage is often incredibly low and the co-pays incredibly high.

In 1958, Delta Dental offered $1000 in dental benefits if you bought their insurance plan. In 1978, I remember Delta still offering the same exact benefit amount, but charging more of a premium. And now in 2011, most dental policies STILL offer a maximum of $1000 in dental benefits if you buy their insurance plan. And premiums for a plan with the same benefits have skyrocketed.

Why is this? Probably because most everyone actually needs regular preventive cleaning and dental work. Dental problems are common across the population, and untreated dental problems tend to compound, spread, and do a lot more damage as they are left untreated for longer. From tooth loss to heart disease and stroke. Therefore, the health insurance companies could not pocket the vast majority of your money and would have to pay out to your dental health care providers more often then they would like to. Consequently, it is less profitable to provide dental health insurance, so they do not. Womp womp womp.

IRS Tax Medical Devices  (We Thought Insurance was Bad Enough) So in this new wave of health consciousness that is re-sweeping the nation, in response to more people being hit with the reality that our unhealthy lifestyles are leaning towards killing us in droves (among other larger systemic factors that I will not explore here), what’s being done on a larger level to promote dental health in this bandwagon?

Whereas groups of cutting edge dentists and non-dental health care providers alike are joining together to promote the oral-systemic health connection, yours truly included, Uncle Sam’s best friend, the IRS (Internal Revenue Service), has decided to levy a new excise tax on medical devices, imposed in section 4191 of the Health Care and Education Reconciliation Act of 2010! And the tax is to go into effect in 2012!

Dental Health Advocacy Coalition: An Attempt to Advise the IRS

Not all medical devices will be taxed extra, fortunately. In section 4191, the law outlines that the term “taxable medical device” does not, however, include eyeglasses, contact lenses, hearing aids, or “any other medical device determined by the Secretary to be of a type which is generally purchased by the general public at retail for individual use.”  Phew.

But what about dental medical devices? It seems that keeping with the tradition of insurance companies, the IRS has yet to include language that includes individual use dental medical devices (like orthodontic products, crowns, and sleep apnea mouthpieces) among those that are tax exempt.Because that last part is ambiguous and disconcerting (“or any other medical device determined by the Secretary…”), a coalition of six longstanding national dental organization authored a letter this March urging the IRS to determine that this new medical excise tax “does not apply to dental devices manufactured by dental laboratories and orthodontic manufacturers.”Let’s keep our fingers crossed. “Devices from dental laboratories, such as crowns, bridges, dentures and other appliances are made and customized and then are delivered directly to the patient by the dentist as part of an overall treatment service. This is also true of orthodontic appliance systems. These devices are designed, fabricated and delivered only for that individual patient’s use. We believe that, for purposes of the excise tax exemption, delivery of a devices from a dental laboratory by a dentist to the patient should be categorized as a ‘retail’ transaction. These items are not intended for resale,” the letter shares with the IRS, in hopes that it will not make the detrimental decision to tax dental health devices made by dental laboratories and orthodontic manufacturers.Here is a link to the letter on the American Dental Association’s Website:

Better Treatment, More Accessible Treatments: We’re Not Giving UpIn sum, all is not lost. Dentists who stay on top of the latest technologies, research, and trainings know that there’s good reason why we’re calling 20011 the ‘Year of the Mouth’.  Recent advances in dental health medicine have introduced early cavity detection lasers (which catch decay before it develops into deeper cavities and allows for us to follow less invasive, less costly treatment plans), the LANAP soft-tissue laser (which can kill oral bacteria and can reverse the damage that periodontitis and gingivitis wreak on your gums, teeth, and jaw bone, saving your teeth and money in the long term), and more dental health education initiatives on the internet (like this blog!), to name a few examples. With these advances, dental healthcare is more accessible and problem prevention is more at our fingertips than ever.

Furthermore it is no longer a secret, how the insurance business model of profit works. By putting down the remote control, we can join up with our neighbors and protect ourselves. We can compel (in many different ways) decision makers to address the health insurance inadequacies in impactful ways. We can become the decision makers ourselves. After all, that’s what a democracy is supposed to be, right?I am more excited about dentistry than ever and far from ever giving up. The foundation of a happy and free person is their body. Confident, healthy, and empowered people is what we need more of, and getting there is a matter far more complex than just what we experience at the doctor’s office. Be aware, be preemptive and proactive, use every last cent of your benefits while you have them, don’t be fooled, and go forth to incite the change!

Dr. Damian Blum                                                          

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