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Dental Plans: Why Americans Are Paying More for Less

iStockphoto/Thinkstock(NEW YORK) -- With all the attention paid to affordable health care, experts say standard dental coverage has changed little over the last 20 years while leading to greater out-of-pocket costs for consumers.

As with the rising costs of overall health care, many times only the wealthiest have access to important dental care.

Dr. Paul Glassman DDS, professor of dental practice and director of community oral health at University of the Pacific, said dental benefits and the cap on dental health plan benefits have not changed much in the past 20 years. But the cost of dental care has increased "dramatically." As a result, more people are paying out of pocket if they want additional work done, he said.

And those who struggle to afford oral health care may find even more problems down the line, with gum disease possibly contributing to ailments like diabetes and heart disease.

Real out-of-pocket dental expenditures increased to $332 in 2008 from $270 in 1996, according to the American Dental Association's (ADA) report published in April called, "Breaking Down Barriers to Oral health for All Americans: The Role of Finance." The ADA said the figure dropped to $323 in 2009, but "this likely reflects the state of the economy, rather than any improvement in dental benefits."

Real per capita expenditures on overall personal health care reached $6,819 in 2009.

Glassman said a number of issues have contributed to dental care's higher costs. One major reason is that labor costs have increased in dental offices.

Sen. Bernie Sanders, I-Vt., introduced a bill on Thursday called the Comprehensive Dental Reform Act of 2012 that tries to fill the gap for the 130 million Americans who have no dental insurance. Medicare covers almost no dental care, and no dental services for the elderly. Medicaid dental benefits vary by state and are often only for the most dire emergencies.

Part of the bill proposes pilot programs for dental therapists, who would have more training than dental hygienists, to perform certain procedures. So far, Alaska and Minnesota allow some dental therapists to provide procedures that only dentists are permitted to do elsewhere. Sanders' bill authorizes National Health Service Corps loan repayments for individuals licensed by a state as dental therapists.

The American Dental Association has opposed this provision of the bill, telling Sanders in a letter that "only dentists can diagnose, develop treatment plans and provide complex treatment."

"Only 20 percent of the nation's practicing dentists provide care to people with Medicaid, and only an extremely small percentage devote a substantial part of their practice to caring for those who are underserved," Sanders said in a statement when he introduced his bill in Washington, D.C. "This bill addresses this by creating an incentive to increase Medicaid reimbursement rates for dentists by assisting the states in covering those costs."

President Obama's Affordable Health Care Act, which will roll out by 2014, will impact some dental policies, such as small group and individual market policies.

"Almost no states cover dental benefits now," said Glassman. "Adults who are low income are almost out of luck in terms of having benefits now."

Burton Edelstein, pediatric dentist and Columbia University professor of dental medicine and health policy and management, said the basic design of dental plans has not changed dramatically over the past 20 years. He said dental plans are "essentially pre-paid dental benefits, rather than risk-shared insurance per se."

Edelstein said under current and proposed legislation, states and the federal government can develop plans to provide more intensive dental care to those with greater needs and less to those who don't need it.

Whether you have an employer subsidized dental plan, there are some steps you can take to make sure you are getting the most affordable dental care you can:

1. Many experts suggest seeking low-cost dental care, such as through Federally Qualified Health Centers. Sanders' bill proposes increasing funding for oral health services at these public clinics, which have a sliding pay scale, and for school-based dental services. He also proposes new funding for mobile and portable services. Glassman is also a proponent of telehealth services in which dentists could provide remote supervision and collaboration without seeing every patient in person.

2. Put money in a health savings account (HSA). Nancy Metcalf of Consumer Reports said she often discourages people who do not have subsidized dental plans from getting individual dental coverage.

3. Research and negotiate prices. Metcalf said allows people to look up prevailing prices for local services. "Call up the dentist and make a deal with them," she said. "Say that you'll go to them for a root canal for $1,000. You're probably going to do just as well if you don't have dental insurance."

Copyright 2012 ABC News Radio

ABC News Radio