This is a question that’s bothered us for a long time. Why aren’t routine eye care and routine dental care covered by health insurance? Put another way, why are certain bones and certain parts of your brain not considered important enough to insure? After all, blindness is a major problem that makes s We found a lot of info explaining what Medicare (specifically) didn’t cover and how to get coverage for those gaps, but very little on WHY the gaps exist in Medicare or in insurance generally. What we did find gave us a few answers…
- Dental/eye insurance doesn’t pay back. The amount you’d spend in premiums is typically more than the amount of coverage you’d get, though as dental and eye expenses rise this is a less relevant problem. From Quora:
“Most dental insurance has annual maximum of $1,000. That’s enough for one crown. Nobody buys a dental plan because they are at risk of a $100,000 bill. They buy dental because they do not want to pay a $600 or $1200 dental bill. But, the $600 annual premium only provides $1000 in maximum benefit if you are willing to pay the $1000 copay (50%). Get a $1200 dental bill and your $600 dental plan plan pays $600 but those expensive procedures are not even covered until the second year.”
- It’s Congress’ fault. From eHealth Medicare-
“Routine dental care, hearing aids, and eyeglasses are statutorily excluded from Medicare coverage. It would take an act of Congress to include routine dental services, hearing aids, and eyeglasses in Medicare program coverage.”
- But the answer we found that made the most sense was that it’s a historical holdover. From SevenDays Vermont-
“As in much of health care, the explanation has more to do with historical factors than with logic or common sense, said Jeanne Keller. Until her retirement two years ago, Keller spent more than 30 years as a health care policy expert, most recently with the Burlington consulting firm Keller & Fuller.
She pointed to the origins of Blue Cross and Blue Shield, which were separate companies until they merged in 1982. The former was founded in 1929 by hospitals as a way to ensure reimbursement for their services. Blue Shield formed a year later to make sure physicians were duly compensated, too.
“So the insurance plans they sell are deeply, historically embedded with the … medical community,” Keller said. In short, Blue Cross and Blue Shield were created by and for hospitals and physicians, who didn’t consider dentists and ophthalmologists “real doctors” — at least where financial reimbursement was concerned.
Not until the 1980s and ’90s did dentists and ophthalmologists begin presenting themselves as primary-care providers and forming their own insurance carriers, such as Delta Dental. Along the way, other health care professionals, such as osteopaths, naturopaths and chiropractors, lobbied to get their own slices of the pie.
Another historical factor, Keller noted, is that health insurance in the U.S. is still predominantly employer-based, unlike the nationalized systems in Canada and the UK. Sure, employers can purchase add-on dental and vision plans if their pool of employees is big enough to make the plans cost-effective. But individuals who try to buy their own dental riders find that insurers tack on long waiting periods to foil consumers who are just trying to cover that root canal surgery scheduled for the following week. As Keller put it, “You can’t buy insurance on your house if it’s on fire.”
Digging Deeper…
Why Don’t Basic Insurance Plans Cover Vision and Dental? Ken Picard in Seven Days Vermont, Feb 2018
Why Doesn’t Medicare Cover Dental Care, Hearing Aids, and Eyeglasses? eHealth Medicare website
Dental, Vision, and Hearing Care with Medicare, Kayda Norman on QuoteWizard, Aug 2018
Why doesn’t health insurance in the US include vision and dental? Quora.com
