Why is dental insurance separate from medical insurance?
Quick caveat: I answered this question in the context of American insurance. It's still not overwhelming common, but dental insurance is sometimes included in medical insurances in other countries.
The short answer
Dental insurance is separate from medical insurance because of a historical division between medical and dental practices. Also there are differences in how dental and medical insurance work which also explain why dental insurance is separate from medical insurance, even though oral health is connected to overall health.
The long answer
Dental insurance is separate from medical insurance because of two main factors: the historical division between medical and dental practices and the differences in how insurance works for both of them.
The division in medical vs. dental care
Dental work was included in barber services up until the mid 1800s. So when you went to get your hair trimmed, you could get a tooth pulled as well. Convenient!
Gradually, the practice of dentistry started to emerge as a separate profession and area of expertise. However, what went on in the mouth generally wasn't regarded as part of the medical realm, and medical schools did not include dental health as part of their studies. In 1840, dentistry was proposed as a medical specialty to the University of Maryland in Baltimore and rejected. Fun fact: Most medical schools still don't include oral health in their curricula much, if at all.
This divide in the medical vs. dental professions contributed to how insurance was designed to cover the costs associated with care.
How insurance works for medical vs. dental services
While there were various forms of medical insurance beforehand, it was more formalized in 1965 when Congress created Medicare within the Social Security Act to provide health insurance to people aged 65 and older regardless of income or medical history. The newly created Medicare notably did not include dental coverage as part of its plans. This omission became the norm in how medical insurance and, later, dental insurance was packaged.
Additionally, the necessity of medical insurance and dental insurance has been viewed very differently. Medical insurance was designed to cover large and unpredictable expenses and thus was seen as more necessary. Dental insurance, on the other hand, is designed primarily to cover lower-cost and predictable care. So there are attitudes that dental insurance is more of a luxury instead of a necessity.
So why isn’t dental covered by health insurance? Simply put, it wasn’t connected from the start due to attitudes from the medical establishment, plus it’s hard to make the insurance case to combine them since medical insurance covers more unpredictable events and dental insurance is more preventative.
However, we are learning more and more about how oral health is connected to overall health. When oral health issues are left untreated, they can turn into serious health complications, exacerbate chronic conditions like diabetes and cardiovascular disease, delay diagnoses of certain health issues, and result in expensive trips to the emergency room. This definitely calls into question more and more about why we insure our mouth differently from the rest of our body.
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Sources
Jain, S. H. (2018, November 19). Medicine and Dentistry: Undoing an Illogical 150-Year Divide. Forbes. Retrieved April 30, 2023, from https://www.forbes.com/sites/sachinjain/2018/11/19/medicine-and-dentistry-undoing-an-illogical-150-year-divide/
Karlis, N. (2019, February 5). Oral Health is crucial to overall health. so why is dental insurance separate from health insurance? Salon. Retrieved April 30, 2023, from https://www.salon.com/2019/02/04/oral-health-is-crucial-to-overall-health-so-why-is-dental-insurance-separate-from-health-insurance/
Morrisey, M. (2013). History of Health Insurance in the United States. In Health Insurance (2nd ed., pp. 3–3). essay, Health Administration Press.
Potetz, L., Freed, M., Jacobson, G., & Neuman, T. (2019, September 18). Policy Options for Improving Dental Coverage for People on Medicare. KFF. Retrieved April 30, 2023, from https://www.kff.org/medicare/issue-brief/policy-options-for-improving-dental-coverage-for-people-on-medicare/
Simon, L. (2016, September 1). Overcoming Historical Separation between Oral and General Health Care: Interprofessional Collaboration for Promoting Health Equity. Journal of Ethics | American Medical Association. Retrieved April 30, 2023, from https://journalofethics.ama-assn.org/article/overcoming-historical-separation-between-oral-and-general-health-care-interprofessional/2016-09
Spector, N. (2017, October 24). The Reason Your Dental Work Isn't Covered by Medical Insurance. NBCNews.com. Retrieved April 30, 2023, from https://www.nbcnews.com/better/health/reason-your-dental-work-isn-t-covered-medical-insurance-ncna813666
