Preventing Dental Debt and Decay

"Despite a lifetime of dedicated brushing, flossing and checkups, I just had to have a root canal and crown on one of my molars. Because I don’t have insurance, I have had to pay $3,800 out of pocket, a huge amount for someone like me. It’s about the cost of my rent for six months. I have a second tooth that also really needs a crown, but I can’t afford it now, so it will have to wait, although I run the risk of damaging it further (and, god forbid, of losing the tooth).” —Graduate School of Arts and Sciences (GSAS) student

Graduate students want dental care. In a survey conducted last spring by the Harvard University Health Services (HUHS), the Graduate Student Council (GSC), and the Harvard Graduate Council (HGC), 90 percent of the 3,300 responding graduate students reported that they thought it was “important” (15 percent), “moderately important” (26 percent), or “very important” (49 percent) for Harvard to make dental coverage available. Yet only 18 percent of the respondents had dental insurance.

The sad fact is that most graduate students simply cannot afford dental insurance or necessary dental care. The majority of graduate students are either taking out enormous loans to finance their post-baccalaureate education or must support themselves and their families on less than $20,000 a year. Faced with a choice of spending their limited funds on rent or for an oral checkup, most students forego a trip to the dentist and hope that problems will not arise or can be ignored. If their luck wears thin during their long years as a graduate student, their options were, until recently, limited. They could join their fellow students who accrue thousands of dollars of long-term dental debt, resort to dental clinics for Medicaid recipients, or pop pain killers between classes for months to ward off tooth pain.

Current research unequivocally demonstrates the importance of dental health for maintaining overall health. The Surgeon General’s Report in 2000 noted that gum disease may increase the risk of stroke, cardiovascular disease, and premature delivery. Untreated cavities elevate one’s risk of esophageal and chest infections. Furthermore, dentists often can notice early oral symptoms of eating disorders and systemic illnesses.

Other universities have recognized the critical role of oral health and have begun to offer dental coverage as a component of their regular health insurance package. For example, students at the University of California, Berkeley automatically receive full coverage for preventive care and 80 percent coverage on most other dental services.

So why has it proven so challenging for graduate students at Harvard to access affordable dental care? Comprehensive dental insurance is expensive. Although you may know people who have “cheap” dental insurance premiums, up to 70 percent of their dental premium is likely paid directly by their employer as an employee benefit. However, nearly 40 percent of Americans are not offered dental coverage by their employer; therefore, a large percentage of Harvard undergraduates and their parents lack dental insurance. To compound problems for graduate students, most individuals over the age of 25 are no longer eligible for coverage under their parents’ employer’s insurance (nor do they qualify for the beneficiary aid offered to some uninsured undergraduates on financial aid). Without an employer to subsidize the costs, they are unable or unwilling to pay the full cost of dental insurance. Those few who still seek to obtain dental care face an additional hurdle: since no companies sell individual dental insurance policies in Massachusetts, students must buy their plan through a group sponsor.

Until 2003, HUHS sponsored an optional dental plan for students. However, financed solely by premiums collected from students ($130 per year) and with a relatively generous benefit cap of $1,500, the HUHS student dental plan was consistently in the red. In an effort to limit losses, HUHS restructured the plan in 2004, increasing the premium to $225 and dramatically decreasing coverage to $400. Student enrollment plummeted from over 2,000 to approximately 350. The remaining students were those who expected to need expensive treatment in the near future; their costs could no longer be defrayed by the premiums of students who had purchased the plan in case costly care was unexpectedly required, but ultimately did not use dental services.

As a result, HUHS discontinued the Student Dental Plan at the start of last spring. HUHS contacted several major dental insurers to develop a substitute, but companies declined to bid on a plan for Harvard students. Instead, HUHS offered students a discount package of $180 for an annual exam, x-ray, and cleaning, and 10 percent savings on treatment at the Holyoke Center.

At a March 2005 open meeting between HUHS representatives and graduate students from across the university, students repeatedly and vocally expressed concerns about the dearth of affordable, timely dental health care options. In response to these complaints, HUHS and a task force of graduate students began to intensively reinvestigate dental care options. The task force received bids from several plans that provide discounted services on other university campuses, as well as a newly-designed plan by Delta Dental.

As a result of the high quality of its in-network dentists and the positive student response to the plan in the spring dental survey, HUHS selected the Preferred One plan of Delta Dental of Massachusetts. While this plan does not provide comprehensive insurance, it does make dental care significantly more affordable. For $210 for an individual (or $525 for a family), a student can obtain basic dental care including annual checkup, x-rays, and semiannual cleanings at no additional charge from an in-network dentist (there are 26 within two miles of the Cambridge campus). Students also receive 30 to 50 percent discounts on fillings, crowns, root canals, impacted tooth removal, gum surgery, and necessary in-network specialty referrals. Detailed information on the plan is available at http://huhs.harvard.edu/HealthnDentalPlans/DeltalOptionsService.htm. All Harvard undergraduate and graduate students are eligible to enroll until Sept. 30.

We heartily applaud the hard work that Harvard University Health Services has invested in developing the Delta Dental option for students. We particularly appreciate their willingness to take on additional administrative hassle, disseminate information about the plan, and collect the registration forms in the absence of any compensation. However, HUHS’ efforts are only a first step. It is time for Harvard to re-examine the importance of dental health for its student community and consider requiring departments to cover the cost of the dental care plan premium as an essential component of students’ financial aid package. Harvard University graduate students should enter the job market with a set of brilliant, healthy pearly whites to match the brilliance of their research, rather than with dental debt or decay.

Jacqueline Hom is a student at the Harvard School of Dental Medicine. Julia Simard is an epidemiology student at the Harvard School of Public Health and was the HGC vice-president of student affairs in 2004-05. Carrie Thiessen is a health policy student at the Harvard Graduate School of Arts and Sciences and is a GSC health services representative. Harvard graduate students Betty Chan, Christine Jesser, and Matthew Zerden, who, with the authors, are members of the Graduate Student Task Force on Student Dental Coverage, also contributed to this op-ed.