Broker blog from Delta Dental

Tag: uninsured

Pediatric dentistry trends in 2021: How COVID-19 has affected children’s oral health

From work to school to every errand in between, the pandemic has affected just about every aspect of daily life, and as we’ve heard over and over again, children are struggling to keep up. As NBC News reports, grades are slipping and absenteeism is soaring. Sadly, and perhaps unsurprisingly, that absenteeism has also surfaced in other cornerstones of child development, including basic health care checkups.

Dropping numbers

Pediatric dental services were down 69% between March and May of 2020 year over year, according to the Centers for Medicare & Medicaid Services. During this time, of course, many practices had temporarily closed their doors. The numbers began to bounce back in May but are still lower than average. Delta Dental of California and its affiliates saw nearly a 10% drop in enrollees between the ages of 3 and 18 receiving exams or dental service from 2019 to 2020.

So, why the low turnout? A few reasons:

  • Apprehensions due to the pandemic. Perhaps the most obvious answer here, but a significant factor, nonetheless. Despite the many precautions taken by health professionals, some parents are still uncomfortable leaving their bubbles just yet. A majority of Americans spent the 2020 portion of the pandemic fearful of contracting the virus, according to a YouGov study. For at-risk parents with few other options, skipping out on these errands can be their only choice.
  • Limited options. With months of closures and capacities limited, simply securing an appointment can be difficult, never mind one at a convenient time. Balancing a home that is suddenly now an office and a school can leave few options for exhausted parents to get their children in the dentist’s chair. Additionally, needed care that might’ve been detected in a school clinic setting may go unnoticed with so many schools still closed. Medicaid beneficiaries are even more likely to struggle with these limitations, according to a poll by C.S. Mott Children’s Hospital at the University of Michigan.
  • Low priority. While small dental procedures are sometimes seen as easy to put off for children who still have baby teeth, there can be long-term effects. Left untreated, cavities can turn to abscesses or hinder the growth of healthy adult teeth.
  • Socioeconomic status. Perhaps the most concerning trend, however, is that of the deepening inequities in health care. The number of children without insurance hit a historic high in 2016 – well before the pandemic hit – and has continued to rise steadily since then, according to a study by Georgetown University. The pandemic, of course, has only exacerbated these issues.

Health care and wealth gaps

As the wealth and health care gap widens due to the pandemic, so do the many ways that such disparities trickle down to the nation’s children. According to the Journal of the American Dental Association, some of the biggest setbacks include:

  • Food deserts. Lack of healthy food options disproportionately affects low-income communities and nearly half of all students rely on free or reduced-price lunches. With schools closed, many families are forced to choose cheap and unhealthy options
  • Unprecedented job loss. With unemployment on the rise, so is lack of insurance or gaps in coverage. For unemployed or underemployed parents, losing employer sponsored coverage can mean unaffordable out-of-pocket costs for themselves and their children. Roughly 6.3% of the U.S. population remains unemployed, as reported in February 2021 by the Bureau of Labor Statistics.
  • Vicious cycle. A 2020 study by the Journal of Dental Research indicated that nearly half of the people who lost dental insurance during the pandemic will likely remain uninsured. This number is estimated to be even higher in states without Medicaid expansion.

Delta Dental and pediatric care

Delta Dental has been making strides to improve health and give back to our young and at-risk neighbors. In 2019, the Delta Dental Community Care Foundation provided nearly $20 million in funding to community organizations ranging from health centers to food banks. Many of the grant recipients are focused on pediatric health, including the Children’s Medical Center Foundation in Dallas, Texas, Family Health Centers of Southwest Florida in Ft Myers, Florida and Healthy Smiles for Kids (HSK) of Orange County, California.

In 2019, the Foundation funded a program through HSK called Prevention, Outreach, Education and Teledentistry (POET), which helps kids receive a comprehensive six-month dental check-up at their school, pediatric office or community sites. With this funding, the program was able to care for more than 25,000 underserved children.

Additionally, Delta Dental launched new teledentistry options this year, including an app called Toothpic. The program is intended to help patients, especially those struggling to make appointments, such as busy parents, get advice from a licensed dentist without leaving home or having to make a real-time appointment. With Toothpic, users simply answer a few questions and snap a photo of problem area. Within 24 hours, they’ll receive custom advice that includes options, costs and information on where they can find a Delta Dental dentist.

What’s next

The good news is that unemployment numbers are gradually dropping while COVID-19 vaccinations steadily rise. While this past year’s statistics may feel somber, they don’t have to be the final word. Affordable health care options like Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children, are more important than ever, as is education about the importance of dental health.

A quick look at people without dental insurance

In 2019, there were almost 74 million people, or nearly 25% of Americans, without dental insurance in the United States. At the height of the unemployment rate’s rise, coronavirus-related job losses and cutbacks left more than 16 million people without dental insurance from an employer. Some of that population will either purchase individual dental coverage, or else find coverage through government plans, but the number of individuals without dental insurance is still expected to increase to as many as 82 million individuals.

Let’s take a closer look at this growing market.

Who are the uninsured?

When examining the 2019 enrollment survey by the National Association of Dental Plans, there are two qualities that jump out when looking at the average uninsured individual.

The first is that people without dental insurance tend to be older than the average American, with an average age of 53.

Second, the uninsured are more likely to be women. Women make up 66% of the uninsured population in America.

Beyond that, the uninsured are a fairly diverse group.

  • Compared to the general population, the uninsured are less likely to be working full-time,with 40% employed and 40% retired. The remaining 20% are unemployed or not working by choice.
  • The uninsured are more likely to be non-Hispanic whites than the general population, at nearly 80% compared to 60.7% for the general population.
  • More than a quarter have children under age 26 at home. Over 40% of the general population has children in this age group at home, so the uninsured are less likely to have children at home than the general population.
  • More than half have some college education. The gap between the uninsured and the general population is very small here. As a whole, just over 50% of Americans over 25 have a bachelor’s degree or higher.
  • More than half of the uninsured are married or in a domestic partnership. A little less than a quarter are single, and the remainder are divorced or widowed.

Why don’t people have dental insurance?

One reason why the uninsured don’t have coverage may have to do with the high average age of the group. They may be retired or reliant on Medicare for insurance, and only Medicare C plans may cover dental. For these individuals, remind them of the low monthly cost of premiums and the size of Delta Dental’s network to help them see that dental coverage is both affordable on a fixed income and easy to access.

There may also be a general lack of information, particularly among those who are retired or jobless and don’t have a benefits administrator to curate plans. Share resources such as Grin! to help them understand why dental coverage is important and what their options are.

Some of the uninsured may have chosen to not have dental insurance, especially if they’ve been looking to cut costs due to changes in their employment status. Over the past year, 39% of Americans reduced or eliminated their insurance for financial reasons, according to Dentistry Today. Of those who have been furloughed or laid off because of COVID-19, this number jumps to 65%.

Common reasons given for choosing not to have insurance include:

  • “My oral health is already good, and I don’t need to visit the dentist.”
  • “Dental insurance isn’t worth the money. I’d rather pay out of pocket.”
  • “I don’t have insurance, because I use a flex spending or health savings account to cover costs.”
  • “The dentist I see isn’t in the insurance network anyway.”

Sharing information about the benefits of dental insurance, even in times of economic uncertainty and the coronavirus pandemic, may help persuade these individuals. You can also remind them that having insurance can be worthwhile because it makes it easier to keep dependents covered, including some adult children.

COVID-19 and the uninsured

The disruptions caused by COVID-19 have affected the uninsured population especially hard. Without insurance to help catch issues early, the uninsured are more likely to have untreated oral health issues and other problems. People with oral health issues and chronic diseases are at higher risk of hospitalization from COVID-19, according to the Centers for Disease Control and Prevention. Having and using dental insurance can help lower the risk of serious complications from COVID-19.

Given that the uninsured population is more likely to be vulnerable to costly dental bills, inadequate dental care and experiencing health issues that go alongside poor oral health, dental coverage is more important than ever before.

How has COVID-19 affected the dental industry?

The new coronavirus (COVID-19) pandemic has significantly altered how the dental industry operates. Here are three ways the pandemic has changed the dental insurance landscape.

Timid patients

There’s an almost daily debate of what constitutes a good reason for leaving your house right now. Individual states are at different stages of re-opening or shutting back down. With so much uncertainty, it makes sense that 42% of patients respondents may skip or postpone care out of fear or discomfort, particularly for non-emergency procedures.

This on top of the 61% of people who already suffer dental fears means that showing patients the extensive infection control measures in place may be an important aspect of getting them back in the chair.

A boom in teledentistry

Teledentistry is a way for dentists to provide a virtual consultation through a phone call, text, or video chat. Dentists can use teledentistry to address problems that don’t need an office visit, which allows them to save time and money on infection control measures like personal protective equipment and sanitizing office spaces. This gives practices an ideal way to assess and triage patients without a risk of exposure, while also potentially allowing a dentist to see more patients in a day.

Even before the pandemic, teledentistry was showing itself as an interesting and promising addition to traditional dental care. It allows dentists to see patients who are at-risk, live in rural areas, or those who just desire the convenience as well as potentially decreasing costs of dental care overall.

The key ingredient to the success of teledentistry is widespread patient acceptance. One possible issue, according to a review of survey’s about teledentistry, is that patients may feel like the quality of care received remotely is not as high as care received in person. However, users in one study were generally satisfied with the experience and respondents in another survey indicated that they would use teledentistry if it was available.

Americans losing health insurance

The biggest shift has been in the number of people with access to health insurance. With millions of jobs lost, many individuals and their families have lost both their coverage from their employers as well as a steady income. According to researchers from the Urban Institute, some individuals will be able to become insured under a family member’s policy, through the Affordable Care Act marketplace, Medicaid or by choosing individual coverage through a broker. Still, that leaves almost 3.5 million people who may become uninsured. With the end of federal programs to support those who have lost their jobs, one big question for the dental industry is whether or not people will make the choice to go to the dentist.

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