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Why Doesn’t Health Insurance Cover Eyes and Teeth?

It basically all goes back to in-fighting between different kinds of doctors, yay

For many Americans, having health insurance is a luxury. Even then, it falls short in a few fundamental areas: For example, basic health insurance plans rarely cover routine eye exams and regular visits to the dentist. (Having working eyes and teeth is just a convenience, I guess, not a necessity. Like, who needs to see and eat?)

Seriously, though: Why do medical insurance, vision insurance and dental insurance usually operate separately? And would it really be so bad if we just lumped them all together? There are a couple answers to this question, one being that insurance (and especially health care) in America is just messy as hell and refuses to change with the times.

That aside, one of the main reasons why our eyes and teeth are ignored by most health-care plans has to do with history and stigma. For one, dentistry and medicine have long been considered to be distinctly different practices. Until the 1800s, barbers served as unsophisticated dentists, pulling teeth and piercing abscesses after giving you a nice, close shave. As time went on, dentistry (and ophthalmology, to some degree) was regarded as less advanced than medicine, which seeped into the minds of Congress while they formulated public health insurance policies in the 1960s. As just one example of the general sentiment during those times, in 1940, an appellate court in New York decided that dentists weren’t doctors, and thus not deserving of the same prestige. 

The result of that sentiment: Today, “less than half of the states provide comprehensive dental care” in their Medicaid coverage, and “you pay 100 percent for eye exams for eyeglasses or contact lenses” if you have basic Medicare. (At least if you have a serious eye problem, like glaucoma or cataracts, you can go to an ophthalmologist, which unlike dentists, are often covered by medical insurance.)

This same stigma has also led to a perception that dental and vision problems are perhaps less serious than “medical” ones, and therefore should be kept separate. (Some people may also mistakenly feel like dental problems are a personal problem that has to do with your own lapses in dental hygiene, whereas medical problems can affect everyone.) But this is a questionable stance: More than 50,000 people will be diagnosed with oral cancer this year. Research has demonstrated links between periodontal infections and chronic conditions, like diabetes and cardiovascular disease. Surely, tons of people end up in the ER because of accidents caused by them not being able to see well enough. And what about all the people who lose out on opportunities because they have a missing tooth? One study found that “losing one tooth results in an annual earnings loss of $720 per year for a typical urban woman working full-time for a wage of $11 per hour.”

Knowing all of this, you could even argue that health insurance companies would save money by helping people afford preventative dental and vision care, before their problems become so bad that they end up turning into a serious medical issue.

But for now, our insurance is the way it is, and backtracking for a moment — history and stigma aside — there are some business-minded reasons why vision and dental are usually separate from the health insurance policies of today. Adam C. Powell, president of Payer+Provider Syndicate health-care consulting, suggests that dental, vision and medical needs are fairly different, and therefore, justify separate insurance policies — at least using the insurance models we have today. “The thing with dental needs and vision needs is that you can project them very easily, more so than medical needs, and they tend not to be catastrophic,” he explains. “The amount that people typically spend on dentistry is rather small, because you can always pull out a tooth, whereas with medical, it’s pretty much the sky’s the limit.”

Because vision and dental insurance are more about preventative care, whereas medical insurance tends to focus on responding to immediate problems, Powell says, “The maximum losses you can have in these two types of insurance are very small, and the insurance products are really more like discount programs, like AAA for your mouth.” Health insurance, on the other hand, is more about risk sharing, where everyone pools money together so the people who do need medical treatment can have it covered and insurance companies can still remain profitable.

All of this is to say that the history of how Americans treat these different aspects of our health has led to different kinds of insurance policies for them. And within our current model, you might even benefit from having the ability to pick and choose. “They could be included in these services, but if they did, they’d increase the costs of the premiums, and not everyone wants dental and vision benefits,” Powell says. “Take me, for example: I don’t have glasses or contacts, so I might elect a vision benefit every couple of years or just pay for a vision screening out-of-pocket.”

“In a way, it would be worse to have a merged plan with the same benefit structure, because if you had a deductible on your health plan, you probably wouldn’t have a lot of dental services covered,” Powell continues. “If you spend too little, you’re better off not having a dental policy.” That’s because routine dental work tends to be much cheaper than, say, an ambulance ride to the hospital.

But again, this is only really because of the ways insurance and health care in America are currently set up, and there are certainly good arguments for merging vision, dental and health coverage together — namely, the societal cost of providing these benefits would be reduced, and pretty much everyone would be healthier.