State lawmakers may forbid dental insurers from imposing waiting periods for pediatric care on new patients.
While dental plans typically cover preventive care immediately, there’s often a waiting period for cavities and other dental work.
The waiting periods – usually three to six months but sometimes as long as a year – kick in when an employee signs up for a new plan or – sometimes – when a company switches dental providers. Children who have coverage through Medicaid do not have any waiting periods if they have cavities, gum disease or need other dental work. A bill would exclude orthodontics from the new rules.
Sen. Heather Sanborn, D-Portland Joe Phelan/Kennebec Journal
The bill, sponsored by Sen. Heather Sanborn, D-Portland, would eliminate the common practice of new patients who purchase family dental plans to have waiting periods for both adults and their children. Children would get care immediately, but adults could still have a waiting period if the bill becomes law.
The bill is expected to go before the Legislature in January. A separate bill, sponsored by Rep. Drew Gattine, D-Westbrook, would establish an adult dental benefit for about 70,000 Medicaid recipients. Gattine’s bill failed in the Legislature last year because the $6.5 million cost wasn’t funded, but lawmakers and advocacy groups will try again in January.
Dr. Jonathan Shenkin, past president of the Maine Dental Association, said it’s common practice for private dental plans to have waiting periods for dental work that’s not preventive care. Shenkin said children are especially vulnerable because they have thinner teeth enamel, and waiting to care for a cavity could cause worse dental health problems later. Or parents would pay thousands of dollars out-of-pocket even though they have insurance.
Insurance companies impose waiting periods to discourage consumers from delaying dental procedures until they purchase coverage and then dropping the coverage after the work is performed.
Shenkin said he believes Maine would be the first state in the nation to eliminate pediatric waiting periods. The time before full benefits kick in is a pitfall that leaves parents with children needing care during the waiting period with no good choices, he said. Either they wait and let their child be in pain for extra months or shell out thousands of dollars, potentially going into debt.
“The waiting periods can put parents in a really tough position,” Shenkin said. “It doesn’t make any sense, and I can’t understand why this is even possible.”
Colin Reusch, director of policy for the Washington-based Children’s Dental Health Project, an advocacy group, said Maine would be a forerunner in eliminating waiting periods if the bill were to pass. He said waiting to take care of problems in pediatric patients can cause harm.
“Tooth decay can advance rapidly in young children,” Reusch said.
Shenkin said a waiting period for an adult has logic behind it. When the adult needs major dental work, he or she could buy a plan for just long enough to get the needed care, such as a root canal, and then quit the plan to avoid paying premiums. But Shenkin said that logic falls apart when talking about pediatric patients, who are reliant on their parents for dental care.
Alexandra Sosnowski, staff attorney for Northeast Delta Dental, a major dental plan provider in Maine and New England, said the company is waiting to gather more information but will work with the Maine Dental Association.
“We will continue to review the bill as it develops, but waiting periods are an important part of certain dental plan designs,” Sosnowski said in a statement. “We are always happy to work with the Maine Dental Association and legislators to increase access to dental care.”
Sanborn said when she heard about the idea from Shenkin it was a “no-brainer” to protect children.
“When you have insurance, there’s an expectation that the insurance will cover what needs to be taken care of,” Sanborn said.
Shenkin said he’s hoping the adult dental benefit for Medicaid enrollees will gain support in January. Maine would join 33 states that currently have full dental benefits as part of Medicaid. Currently, Maine’s Medicaid program will only cover adult patients who have emergency dental needs.
“We are currently subjecting people to a very low standard of oral health care,” Shenkin said
Advocates have argued that while paying for prevention has costs, it also saves money in the health care system because good dental care can prevent other diseases. A 2017 study for the National Association of Dental Plans found that a preventive Medicaid benefit for adults reduces medical costs by 31 percent to 67 percent for patients with chronic conditions, such as diabetes, high blood pressure, high cholesterol and asthma.
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