Why doesn't health insurance cover dental care?

Under Medicaid today, dental care is usually covered only for children and sometimes pregnant women. Just 12 states include the full suite of dental services, including common procedures like crowns and root canals, for Medicaid patients. Three offer nothing at all. The rest provide something in between—usually a list of preventative procedures, like cleanings and X-rays, and sometimes extractions and fillings. Maryland is in this dental middle ground, covering cleanings, fillings, and diagnostics. When it comes to crowns, root canals, bridges, or implants, though, low-income Maryland residents have few options other than paying out of pocket…

Indeed, several people I met at the dental clinic seemed fundamentally perplexed about how dental insurance would work, if they had it. A woman named Crystal, also from Waldorf, needed three fillings and hasn’t gone to the dentist in years. She qualifies for insurance through her job at Macy’s, and she at first attributed her lack of insurance to “procrastination.” Later, though, she admitted that it seemed expensive, and that people had told her it would cost more to have dental insurance than to simply pay out of pocket, but she wasn’t sure.

An older woman named Cheryl, who had been in line since 2:00 a.m., had broken a tooth three weeks ago and was now living with “a raw, open nerve.” She said she just qualified for Medicare, the health insurance program for seniors, and she hopes to enroll soon. Then she paused a minute.

Under Medicare, “I don’t know if dental is included,” she said. (It’s not.) By comparison, she said, the UMD clinic seemed like a good option. “For free? I’m prepared to wait. I would stand on one leg.”