© 2016 American Dental Association All Rights Reserved. October 2016
Dental Benefits Coverage Increased for
Working-Age Adults in 2014
Authors: Kamyar Nasseh, Ph.D.; Marko Vujicic, Ph.D.
Introduction
Dental benefits are an important driver of dental care use. An individual with private dental
benefits is twice as likely to visit a dentist compared to a person without any benefits.
1
Studies have shown that expansions in adult Medicaid dental coverage increase utilization
2
,
3
and that the capacity exists within dental offices to treat additional patients.
4
The decline in
private dental benefits coverage has been strongly associated with a drop in dental care
utilization, particularly among working-age adults.
5
Conversely, dental care utilization among
children and the elderly increased over the past decade. As of 2014, utilization of dental care
among the elderly is at its highest level since the Medical Expenditure Panel Survey (MEPS)
began measurement in 1996.
6
Increased dental care utilization among children has been
primarily driven by the expansion of dental benefits in Medicaid and the Children’s Health
Insurance Program (CHIP).
7
As of 2013, the percentage of children lacking dental benefits
was at its lowest rate since the MEPS began tracking dental insurance coverage in 1999.
8
There is evidence that the Affordable Care Act (ACA) is having an impact on the uptake of
private dental benefits, particularly among young adults. Although the ACA did not mandate
that young adults under age 26 could stay on their parents’ private dental insurance policies,
Research Brief
Key Messages
From 2013 to 2014, the percentage of working-age adults lacking dental benefits
dropped and the percentage with private dental benefits coverage increased.
The percentage of children lacking dental benefits continued to fall in 2014 and is now at
its lowest level since 1999, the first year that data became available.
It is still too early to tell whether increases in dental benefits coverage will boost dental
care utilization, particularly among working-age adults.
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Research Brief
there is evidence that the dependent coverage policy
had a “spillover effect” on the uptake of dental benefits.
Through 2013, private dental benefits coverage and
dental care use increased among young adults.
9
-
11
There is also evidence that more individuals are
purchasing dental benefits in the federally-facilitated
marketplace (FFM). In 2016, the take-up rate of stand-
alone dental plans in the FFM was at 15.1 percent and
13.2 percent among adults and children respectively.
Approximately 1.3 million adults and 114,037 children
selected a stand-alone dental plan in the FFM in
2016.
12
More broadly, through the health insurance
marketplaces and Medicaid expansion, the ACA has
the potential to alter the dental benefits landscape for
adults and children.
In this research brief, we update previous research
13
and analyze trends in dental benefits through 2014
using newly released data.
Results
In Figure 1, we break down the source of children’s
dental benefits by year for 2000-2014. The percentage
of children with private dental benefits held steady from
2013 (49.8 percent) to 2014 (50.3 percent). The
uninsured rate among children decreased from 12.2
percent in 2013 to 11.0 percent in 2014, the lowest
level since the MEPS began tracking dental insurance
coverage in 1999.
14
This change was statistically
significant at the 10 percent level. The percentage of
children with public dental benefits also held steady
from 2013 (38.0 percent) to 2014 (38.7 percent). The
overall change in the percentage of children with
private dental benefits, public benefits or no dental
benefits from 2000 through 2014 was statistically
significant at the 1 percent level.
Among working-age adults (Figure 2), the percentage
with private dental benefits increased from 56.2
percent in 2013 to 58.1 percent in 2014. The uninsured
rate among working-age adults fell from 33.3 percent in
2013 to 29.4 percent in 2014. From 2013 to 2014, the
percentage of adults in Medicaid rose from 10.5
percent to 12.5 percent. Using data from the American
Community Survey (ACS), we estimate that 53.8
percent of Medicaid-enrolled adults in 2014 lived in a
state that provided adult Medicaid dental benefits.
Thus, we estimate that in 2014, 6.7 percent of all
working-age adults were enrolled in Medicaid
programs that provided adult dental benefits. From
2013 to 2014, changes in the percentage of working-
age adults with private dental benefits, Medicaid
benefits or no benefits were statistically significant at
the 1 percent level. All changes from 2000 to 2014
were also statistically significant.
For the elderly, there was little change in the
percentage of individuals with private dental benefits,
public benefits or no insurance. The percentage with
private dental benefits rose from 27.4 percent in 2013
to 27.9 percent in 2014, a statistically insignificant
change. However, the overall increase in the
percentage of elderly adults with private dental benefits
from 2000 (23 percent) to 2014 (27.9 percent) was
statistically significant at the 1 percent level (Figure 3).
In Figure 4, we examine the percentage of the
population with private dental benefits for narrower age
groups. From 2013 to 2014, the percentage of adults
ages 19-25 with private dental benefits held steady
from 2013 to 2014. The percentage of adults ages 26-
34 with private dental benefits increased from 52.5
percent in 2013 to 55.0 percent in 2014, a change that
was statistically significant at the 10 percent level. The
percentage of adults ages 35-49 with private dental
benefits increased from 59.1 percent in 2013 to 61.5
percent in 2014, a change that was statistically
significant at the 5 percent level. Among adults ages
50-64, the percentage with private dental benefits also
increased from 2013 (57.2 percent) to 2014 (59.4
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Research Brief
percent), a change that was also statistically significant
at the 5 percent level.
Discussion
In 2014, working-age adults made gains in dental
benefits coverage. Compared to 2013, a higher
percentage of working-age adults, particularly adults
ages 35 to 64, had private dental benefits. In addition,
we estimate that 6.7 percent of working-age adults had
dental benefits through Medicaid in 2014. These 2014
trends could be a result of the Affordable Care Act,
namely the Medicaid expansion provision as well as
the establishment of health insurance marketplaces
where adults can purchase dental benefits. Since most
adults with private dental benefits obtain them through
their employer, economic trends could also play a role.
The percentage of children without any form of dental
benefits continued to fall in 2014 and is now at its
lowest level since the MEPS began tracking dental
insurance coverage in 1999. There was also a slight
uptick in the percentage of elderly adults with private
dental benefits in 2014, although this change was not
statistically significant.
As we show in a companion analysis, there were no
significant changes in the percentage of children,
working-age adults or elderly adults with a dental visit
in 2014. Although not statistically significant, there was
a 2.5 percentage point increase in the share of low-
income working-age adults who visited the dentist.
6
Financial barriers to dental care are also falling among
poor adults.
15
However, we will need additional years
of data to determine whether the ACA, and Medicaid
expansion in particular, are having a lasting impact on
access to dental care, particularly among the poor.
Figure 1: Source of Dental Benefits, Children Ages 2-18, 2000-2014
Source: Health Policy Institute analysis of the Medical Expenditure Panel Survey, AHRQ. Notes: All changes were significant at the
1% level (2000-2014). The change in uninsured from 2013 to 2014 was statistically significant at the 10% level.
57.8%
57.3%
55.2%
55.6%
54.7%
53.9%
54.5%
52.0%
52.1%
52.0%
48.7%
49.0%
49.7%
49.8%
50.3%
20.5%
23.0%
25.8%
27.1%
28.3%
29.9%
29.8%
30.9% 30.6%
32.5%
35.5%
36.8%
37.2%
38.0%
38.7%
21.7%
19.7%
18.9%
17.3%
17.0%
16.2%
15.6%
17.1%
17.3%
15.4%
15.8%
14.2%
13.1%
12.2%
11.0%
0%
20%
40%
60%
80%
100%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Private Public Uninsured
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Research Brief
Figure 2: Source of Dental Benefits, Adults Ages 19-64, 2000-2014
Source: Health Policy Institute Analysis of the Medical Expenditure Panel Survey, AHRQ. Notes: Changes for public and uninsured
were significant at the 1% level (2000-2014). Changes for private were significant at the 5% level (2000-2014). All changes from 2013
to 2014 were statistically significant at the 1% level.
Figure 3: Source of Dental Benefits, Adults Ages 65 and Older, 2000-2014
Source: Health Policy Institute analysis of the Medical Expenditure Panel Survey, AHRQ. Notes: Changes in private and uninsured
were significant at the 1% level (2000-2014). All changes from 2013 to 2014 were not statistically significant.
61.0%
61.5%
60.8%
59.6%
60.2%
60.1%
59.5%
59.1%
57.6%
56.9%
56.1%
56.2%
55.9%
56.2%
58.1%
6.5%
6.5%
7.4%
7.7%
8.0%
7.9%
7.8%
7.9%
8.4%
8.6%
9.3%
10.0%
10.1%
10.5%
6.7%
5.8%
32.5%
32.0%
31.8%
32.8%
31.8%
32.0%
32.7%
33.0%
34.0%
34.5%
34.6%
33.7%
34.0%
33.3%
29.4%
0%
20%
40%
60%
80%
100%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Private Public Public (with dental benefits) Public (without dental benefits) Uninsured
23.0%
24.2%
24.5%
23.1%
23.8%
24.5%
24.0%
22.2%
23.3%
22.7%
23.9%
26.1%
25.9%
27.4%
27.9%
9.1%
9.1%
9.7%
9.6%
10.4%
11.5%
10.3%
10.6%
9.3%
9.4%
9.7%
9.7%
10.2%
10.7%
10.1%
67.9%
66.6%
65.8%
67.3%
65.8%
64.1%
65.7%
67.2%
67.4%
67.9%
66.4%
64.2%
63.9%
61.9%
62.0%
0%
20%
40%
60%
80%
100%
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Private Public Uninsured
5
Research Brief
Figure 4: Percentage with Private Dental Benefits for Select Age Groups, 2000-2014
Source: Health Policy Institute Analysis of the Medical Expenditure Panel Survey, AHRQ. Notes: Changes for children 2-18, adults
26-34 and adults 65 and older were statistically significant at the 1% level (2000-2014). Changes for adults 35-49 were significant at
the 5% level (2000-2014). Changes for adults 26-34 from 2013 to 2014 were significant at the 10% level. Changes from 2013 to 2014
for adults 35-49 and adults 50-64 were significant at the 5% level.
Data & Methods
We analyzed data from the Medical Expenditure Panel
Survey (MEPS) that is managed by the Agency for
Healthcare Research and Quality (AHRQ). The MEPS
is a large-scale survey of individuals and families
drawn from a nationally representative sample (the
“household component”). The MEPS is the most
complete source of data on the cost and use of health
care and health insurance coverage.
16
We focused on
the period 2000 to 2014, the most recent year for
which data are available (data for 2014 were released
in September 2016). We used data from the MEPS to
analyze the source of dental benefits for children (ages
2-18), working-age adults (ages 19-64), and the elderly
(ages 65 and older).
We classified dental benefits into two categories: public
and private. Public benefits include those provided
through Medicaid or CHIP. Because dental services
are a mandated benefit within Medicaid and CHIP, all
children enrolled in these programs were defined as
having public dental benefits. As noted, Medicaid
coverage of dental benefits for adults is optional and
varies considerably by state. The MEPS does not allow
us to identify the state of residence. However, we use
the 2014 American Community Survey (ACS) to
determine the share of publicly insured working-age
adults in 2014 that live in states that provide an adult
Medicaid dental benefit.
17
Because Medicare does not
provide dental benefits,
18
persons who only had
Medicare coverage (and no form of private dental
benefits) were considered uninsured for dental care.
6
Research Brief
We test for statistical significance across time using a
chi-squared test. Our point estimates and statistical
inferences take into account the complex survey
design of the MEPS.
.
This Research Brief was published by the American Dental Association’s Health Policy Institute.
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Research Brief
References
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12
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13
Nasseh K, Vujicic M. Dental benefits coverage rates increased for children and young adults in 2013. Health Policy
Institute Research Brief. American Dental Association. October 2015. Available from:
http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_1015_3.pdf?la=en. Accessed
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14
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Research Brief
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18
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Suggested Citation
Nasseh K, Vujicic M. Dental benefits coverage increased for working-age adults in 2014. Health Policy Institute
Research Brief. American Dental Association. October 2016. Available from: https://www.ada.org/-/media/project/ada-
organization/ada/ada-org/files/resources/research/hpi/hpibrief_1016_2.pdf.