Seattle-area dental insurance is ‘like a joke.’ But few are smiling (2024)

There’s no shortage of reasons why people avoid seeing the dentist. But in the Seattle area, the cost of dental care is a big one.

Take Seattle resident Leia Berry, a patient care representative for a regional cancer center. An X-ray last month revealed she needs to replace a crown and get some other work done, but she can’t afford the $1,500 out-of-pocket expense.

“I have insurance, but the insurance is just like a joke,” Berry said. “It barely covers anything except for the teeth cleanings.”

So, she’s decided to put off treatment.

“As sad as it sounds, until I actually have mouth pain, I honestly can’t go and get these done. It’s not an emergency at this point.”

Berry is not alone. Squeezed by Seattle-area costs of living, more people have been cutting out routine appointments and delaying needed but expensive dental work, advocates say. Some area residents told The Seattle Times they haven’t seen a dentist in years. Some find it more affordable to travel to Mexico for dental procedures where the care, they say, is about a third of the cost.

The affordability of dental care is a complicated problem. Advocates say access to reasonably priced dental care will remain an issue until dental plans more closely resemble medical insurance, but some worry that might also lead to a spike in premiums and employers dropping plans.

Advocates also say access to care needs to greatly expand for people at lower incomes.

“The need is great, and the number of low-income individuals, uninsured individuals, is significant,” said Kelli Nomura, CEO of the International Community Health Services, one of a few community health centers in the area that provides low-cost dental services.

Nationwide, the dental services’ costs to consumers rose 5% last year, 6.4% in 2022, and increased in the range of 2.2%-3% from 2019-2021, according to the U.S. Department of Labor’s consumer price index.

Operating costs at the private dental clinics also have spiked during that time, said Bracken Killpack, executive director of the Washington State Dental Association.

A shortage of dental hygienists has been a main driver of higher costs in the Seattle area, said Killpack. The median hourly wage last year for a dental hygienist was $42 nationally, whereas the median in Washington was $61. Anecdotally, wages are higher in Seattle, he said.

“It drives up the cost of care, and it does make it incredibly expensive compared to other places,” Killpack said.

Facing high costs, many have to make tough choices when it comes to dental care.

Julia Colson, project executive of the Seattle/King County Clinic, a free, pop-up clinic held at the Seattle Center once a year, said more people are likely putting off needed treatments.

“When they’re having to choose between housing, food, medications, and other forms of insurance, given the high cost of living, preventive care is not where they’re putting their money,” she said.

Berry said renting in the Columbia City neighborhood has eaten into the family’s equity from a home sale before moving to Seattle from Memphis, Tenn. She and her husband work full time for a cancer center, but they’re trying to rebuild their savings and tighten up. Their two teenage daughters, one college-bound, are the priority.

Last year, she had to pay $1,000 out of pocket for a bridge and doesn’t want to put another big dental charge on her credit card.

“I can’t just be living paycheck to paycheck, and at this point I would have to take it out on credit,” Berry said. “And for the first time in my life, I am not in any debt.”

Annual caps

State Rep. Michelle Caldier, R-Gig Harbor, a former dentist and dentistry professor at the University of Washington, argued that the low annual caps on dental plans are the No. 1 barrier to affordability and access. Nationwide, about 61% of adults have private dental insurance, according to the American Dental Association.

Many dental plans only cover a maximum of around $1,500 per year, and the rest is out of pocket. She said the yearly maximum hasn’t changed much since she was a practicing dentist eight years ago.

“Could you imagine if your homeowner’s insurance maxed out at $20,000 and you had a fire and they paid you $20,000?” she said. “I mean, that’s not insurance.”

Caldier said it might take state legislation to force dental insurance companies to raise the coverage amounts.

“Typically, the dental insurance will cover a routine cleaning and radiographs and maybe one filling a year,” she said. “If you need a root canal, $1,500 doesn’t go far.”

Michael Adelberg, executive director of the Washington, D.C.-based nonprofit National Association of Dental Plans, disagrees that annual caps are a problem. He noted only around 4% of policyholders nationwide max out their annual limits. He also said the caps have been rising, and 7% of all dental plans have no limits, up from 1% a few years ago.

“There’s a trend line toward higher protection,” Adelberg said. Dental insurance companies also negotiate fee schedules with dentists, thus controlling the costs of certain procedures. But, he noted, if dental plans were to be structured like medical insurance, premiums would have to rise.

“As an industry, dental plans [providers] are quite happy to offer plans with higher annual limits, but they have to charge for it,” Adelberg said. “It’s just math.”

Access to low-cost care

The Seattle area has a network of community clinics that offer dental care to low-income families with Medicaid insurance, known as Washington Apple Health, and on a sliding scale and reduced fees for the uninsured, but advocates say there aren’t enough of these clinics.

Many private dental clinics won’t accept Medicaid insurance because the reimbursem*nts are too low, Caldier said.

Nomura’s International Community Health Services has four dental locations in the Seattle area, a mobile dental clinic and Seattle World School, a school-based dental clinic. It serves a high population of people of color, particularly Asian populations, as well as undocumented immigrants.

“It’s very difficult for Medicaid recipients to find places that take Medicaid for dental, and our community health centers are one of the few that do that,” Nomura said.

She said many patients check in to ICHC clinics with serious problems. “They come to us with escalating dental needs that may require more appointments, more procedures because they have not been receiving ongoing dental care on a regular basis,” Nomura said.

Nationwide, a high percentage of Americans infrequently see a dentist, according to American Dental Association surveys. In 2021, just 39% of adults and 20% of lower-income adults reported going to a dentist within 12 months, a percentage that’s been consistent over two decades. The percentages for Black and Hispanic adults were 28% and 24%, respectively.

ADA surveys also suggest that in recent years between 30% and 35% of lower-income adults do not obtain needed dental work because of the cost.

Ruth Prudence, 42, who lives in the Central District, said she hasn’t seen a dentist in 10 years. Unemployed and without insurance, she said she visited a dentist every six months as a young adult but has no means to go right now.

“I wish I could go to the dentist,” she said. “I wish I had these things available, but I am not a trust fund baby.”

Colson’s Seattle/King County Clinic also gets severe cases. Volunteer dentists treat about 1,500 people over four days in 90 dental chairs, providing free cleanings, fillings, extractions and more advanced procedures. Most of the patients have housing and more than 60% are employed.

She remembered one man had to have every tooth in his mouth pulled.

“People are having to wait and sometimes they are waiting through the pain,” she said.

Losing trust

The business of dentistry has been changing with escalating overhead expenses and the pressures of providing care and running a business.

“You see more and more corporations taking over dental practice and consolidating it into a larger operation,” Colson said. Corporate-owned dental clinics, she added, tend to be less flexible in their policies and fee structures than independents.

Some Washington patients said they’ve lost trust in the system as the business has changed.

“It used to be the Norman Rockwell dentist on the corner, that’s all in the past,” said Don Smith, 59, who lives in Kennewick. “They look like fast food joints.”

Jim Freeburg, 42, of Renton, said his beef is that the system lacks price transparency. He was recently referred to a periodontist for a gum graft.

Freeburg, who is executive director for the Patient Coalition of Washington, tried to shop around, but it took him several calls to get an estimate. His out-of-pocket cost was $4,400 for four procedures.

“I just want to know what’s it going to cost me,” he said. “It’s been very challenging to find that out.”

Some Pacific Northwest residents are also finding a cheaper option in Mexico.

Deborah Wilson, an executive at a pet care retailer who lives in West Seattle, visits a dentist on the Baja Peninsula near Cabo San Lucas on her frequent trips there. But the lower cost is only one reason. She likes that dentists in Mexico do the cleanings themselves.

“I’ve met so many people that go down there that do this,” she said. “I have met Americans and Canadians both.”

Bellingham retiree Neal Bittner is another. He and his wife see a dentist in a village south of Puerto Vallarta where they have a winter home.

“We had a very good dentist up here that we really liked, but he was just so darn expensive,” Bittner said.