HHS’s HRSA reported that in 2011, over 4 million patients used dental  services at federally funded health centers. National Survey Data Show That Rates of Dental Coverage and Use of Dental Services Remained Generally Unchanged from 1996 to 2010

The rate of individuals with dental coverage remained largely unchanged  from 1996 to 2010; around 62 to 63 percent of the population had private  or Medicaid or CHIP dental coverage. Coverage of Dental Services Remained Relatively Unchanged from 1996 to 2010

Our analysis of MEPS data showed that overall, the rate of dental  coverage—the percentage of individuals reporting that they had dental  coverage through private insurance or Medicaid or CHIP—remained  relatively unchanged from 1996 to 2010.62 percent of individuals reported having dental coverage, and in 2010,  63 percent reported having dental coverage. For about 10 to 12 percent   Specifically, in 1996,   of the population, including many individuals covered by Medicare and  other federal health programs, dental coverage status is unknown. 1). The percentage of  individuals reporting that they did not have dental coverage decreased  from 28 percent in 1996 to 25 percent in 2010, leaving at least one in four  individuals with no dental coverage—approximately 76 million people—in  2010. 2). 3). This increase reflects an increase in the  number of children with Medicaid coverage who had a dental visit,  although these children still had dental visits at lower rates than privately  insured children (58 percent). Average annual  inflation-adjusted dental payments increased 26 percent from $520 per  year in 1996 to $653 per year in 2010 (see table 5). The average annual  payments made—including out-of-pocket payments and payments by  other payers—increased 24 percent for the privately insured, 39 percent  for individuals with Medicaid, and 38 percent for those without dental  coverage. Specifically, average annual  out-of-pocket payments made by individuals with private coverage  increased 21 percent from 1996 to 2010—from $242 to $294. Individuals  with no dental coverage experienced the greatest increase in average  annual out-of-pocket payments, from $392 to $518, a 32 percent  increase. Dental fees also varied between local dentists  and health centers that serve residents of the same community, but all  health centers are required to offer sliding fee schedules for low-income  individuals. Upper-end fees were at least double the  midpoint fees in at least one community for 8 of the 24 common  procedures we examined (see table 6). For example, in Miami, Florida,  half of the fees charged by dentists for a periodic oral examination of an  established patient were $62 or less, but 5 percent of fees charged for  that procedure were $150 or more, a 142 percent difference. Dental fees also varied between midpoint fees of local dentists billing  private insurers and the full fees of the federally funded health centers  that serve residents of the same community. IV for additional information on local  dentist fees and health center dental fees.) Agency Comments

HHS reviewed a draft of this report and provided technical comments,  which we incorporated as appropriate. 9). Appendix III: Scope and Methodology

To provide information on the trends in dental coverage rates, use of  dental services, and payments by individuals and other payers for dental  services, we analyzed nationwide data from the Medical Expenditure  Panel Survey (MEPS). To determine the extent to which dental fees varied between and within  selected communities, we analyzed dental insurance claims data and  dental fees charged by selected health centers in nine states  corresponding to the nine U.S. Census Bureau divisions. For each selected dental procedure, we extracted from the FAIR Health  data set the midpoint dental fee (the 50th percentile) and the upper-end  fee (the 95th percentile). Oral Health: Dental Disease Is a Chronic Problem Among Low-Income  Populations.
Why GAO Did This Study

High rates of dental disease remain prevalent across the nation, especially in vulnerable and underserved populations. According to national surveys, 42 percent of adults with tooth or mouth problems did not see a dentist in 2008 because they did not have dental insurance or could not afford the out-of-pocket payments, and in 2011, 4 million children did not obtain needed dental care because their families could not afford it.
In 2011, the Institute of Medicine reported that there is strong evidence that dental coverage is positively tied to access to and use of oral health care. For families without dental coverage, federally funded health centers may offer an affordable dental care option. Health centers are required to offer sliding fee schedules with discounts of up to 100 percent for many low-income patients.
GAO was asked to examine dental services in the United States. This report describes (1) trends in coverage for, and use of, dental services; (2) trends in payments by individuals and other payers for dental services; and (3) the extent to which dental fees vary between and within selected communities across the nation. To do this work, GAO examined HHS national health survey data and national dental expenditure estimates, dental insurance claims data, and health center dental fees in 18 selected communities (based on census region, population, and dental claims volume). GAO also interviewed HHS officials and academic experts.
HHS provided technical comments on a draft of this report, which were incorporated as appropriate.

What GAO Found

Overall, trends in dental coverage show little change from 1996 to 2010--around 62 percent of individuals had coverage. The percentage of the population with private dental coverage decreased from 53 to 50 percent. Dental coverage through Medicaid or the State Children's Health Insurance Program (CHIP), which was established in 1997, rose from 9 to 13 percent. The increase was due primarily to an increase in the number of children covered by these federal-state health programs with mandated pediatric dental coverage. Individuals with no dental coverage decreased from 28 to 25 percent, and coverage for 10 to 12 percent of the population was unknown. Use of dental services--the percentage of individuals who had at least one dental visit--also remained relatively unchanged at around 40 percent from 1996 to 2010. Medicaid and CHIP beneficiaries, children in particular, showed increases in the use of dental services (from 28 to 37 percent), but still visited the dentist less often than privately insured children (58 percent in 2010).
GAO's analysis showed that average annual dental payments--the total amount paid out of pocket by individuals and by other payers--increased 26 percent, inflation-adjusted, from $520 in 1996 to $653 in 2010. Average annual out-of-pocket payments increased 21 percent, from $242 to $294, for individuals with private insurance and 32 percent, from $392 to $518, for individuals with no dental coverage.
Dental fees charged by local dentists and health centers varied widely. For 8 of 24 common procedures GAO examined, reported upper-end fees (the 95th percentile of the range in local dentist fees) were at least double the midpoint fees (the 50th percentile of the range in local dentist fees) in several communities. For example, in Miami, Florida, the upper-end fee of $150 for a periodic oral examination was more than twice the midpoint dental fee of $62. Dental fees also varied between local dentists billing private insurers and health centers serving residents of the same community. In general, most health centers in GAO's review offered a 100 percent discount--resulting in no fee--to the lowest-income patients for many, but not all, dental services.