Jackie Duda, after a perilous bout with sepsis, found herself on a long road to recovery, one marked by extensive medical bills that soared beyond $250,000. Yet, despite the financial strain, she never faced a denial of care during her hospital stay. The 61-year-old resident of New Market, Maryland, however, hasn’t been as fortunate when it comes to her dental costs. As a freelance health journalist, she has come to realize just how complicated the situation is.
Duda’s Medicaid coverage doesn’t extend to dental implants, though these are vital to replace the three teeth irreparably damaged due to her sepsis and another chronic illness. Even with a reduced price offered through the University of Maryland’s dental program, the $6,000 bill remains out of her reach. She plans to rely on a high-interest Care Credit loan to pay for the work, adding yet more debt to her already mounting credit card balance. Her adult children have graciously stepped forward to offer financial help, alongside her husband, who, despite being on disability, works part-time at Sam’s Club.
“Who has that kind of money just sitting around?” Duda muses, frustration clear in her words. “Hospitals at least try to negotiate with you or waive part of the costs, but I’ve never encountered a dentist who was willing to do that.”
The disparity in dental care across America is staggering. While some people live with excruciating pain or are burdened by the embarrassment of decaying teeth, others flaunt perfect veneers that cost tens of thousands. There’s no governmental safety net for the millions who lack dental insurance, and even those with coverage often find it difficult to shoulder the burden of out-of-pocket costs for significant dental work. The Affordable Care Act, which has extended health insurance to millions since its inception in 2014, doesn’t mandate adult dental coverage. This leaves a significant portion of the population routinely unable to access necessary dental care.
Duda, like many, is faced with a tough decision. Care Credit, along with other medical credit card services, comes with a major caveat: sky-high interest rates if balances aren’t paid off within a short window. A report from the Consumer Financial Protection Bureau, issued on July 2, highlighted the concerning rise in consumer complaints regarding how medical credit cards were marketed and sold by dentists and other health professionals.
With no other option, Duda intends to apply for a Care Credit loan ahead of her dental procedure next month, knowing full well the financial strain it could cause.
The dilemma patients face is rooted in a fundamental issue: the extent to which medical professionals feel obligated to provide care to all, regardless of financial means. In general healthcare, the standards are more lenient—hospitals are legally bound to treat and stabilize patients, whether or not they can afford it. Dental practices, however, don’t have such obligations. Many operate as independent businesses and frequently turn away those unable to pay.
Dentists argue that they, too, have overhead to manage—salaries for hygienists, office staff, and costly equipment. On top of that, many face significant student loan debt; the average dental school graduate in 2023 carries $296,500 in loans, a figure that surpasses what most doctors owe after medical school.
Though dentists do offer discounted or free services in certain cases, there are limits. In 2018, the American Dental Association Health Policy Institute estimated that dental professionals provided $800 million in discounts and $1.6 billion in pro bono work. Additionally, about 6.1 million individuals in 2022 received dental care at federally funded community health centers, which cater to underserved populations. But the need far outweighs what can be offered through these channels.
“We all went into this profession to help the communities we serve, but there are limits,” said Brett H. Kessler, president-elect of the American Dental Association. “We can’t provide free care indefinitely.”
There are proposed solutions on the horizon, but they face significant political hurdles, especially with an election looming. The Biden administration has introduced a rule allowing states to offer dental insurance for adults under the Affordable Care Act. Meanwhile, Senator Bernie Sanders of Vermont is pushing for a more robust plan. His proposal seeks to broaden dental coverage through Medicare, Medicaid, and the Veterans Administration while also increasing the number of dental professionals across the country.
Sanders has been vocal about what he sees as a nationwide crisis in dental care, with too many Americans left without access to basic oral health services. A recent report by the nonprofit CareQuest Institute for Oral Health revealed that nearly 69 million U.S. adults lacked dental insurance or routine oral care last year.