The Welfare Implications of Expanding Dental Coverage in the United States: Evidence from Dental Expenditures, Utilization, and Financial Barriers to Care
Using 2024 MEPS data analyzed with rigorous survey-weighted methods, this study finds that US dental insurance significantly increases utilization and reduces financial barriers to care without driving up per-visit spending, suggesting that expanding coverage would primarily improve access rather than induce costly overuse.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Oral health is a fundamental part of how people live, affecting everything from nutrition to the ability to work, yet in the United States, dental care occupies a strange and separate place in the health system. While children are guaranteed dental coverage under federal law, adults often must buy it separately or go without it entirely, even if they have full medical insurance. This separation creates a financial hurdle for many; without coverage, the cost of a routine checkup or a necessary filling can be a barrier that stops people from seeking help. When people delay care because of cost, minor issues can turn into painful infections or tooth loss, and the problem often ends up in emergency rooms where it is more expensive to treat and less likely to be solved. Economists and policy experts have long debated what happens when people finally get dental insurance. The standard theory suggests that when insurance lowers the price a person pays at the counter, they will use more services. The big question is whether this increased use is simply people getting the care they needed all along, or if it is people using more services than they actually need just because the price is low.
A recent study published in September 2026 by Patrick Nyenkan of Texas Tech University tackles this question by looking at a massive, nationally representative snapshot of American life. The researcher used data from the 2024 Medical Expenditure Panel Survey, a comprehensive government project that tracks how millions of people spend money on health care. By linking information about who had dental insurance with records of who actually visited a dentist and how much they spent, the study aimed to understand the real-world effects of coverage. The analysis was rigorous, accounting for the complex way the survey was designed to ensure the results reflected the entire population, not just a biased sample. The study focused on three specific outcomes: whether people went to the dentist at all, how much money they spent if they did go, and whether they reported being unable to afford the care they needed.
The findings paint a clear picture of how dental insurance functions in the current system. The data showed that having insurance is strongly linked to actually getting care. Among people with dental insurance, about 56.6 percent visited a dentist in 2024, compared to only 37.1 percent of those without it. When the researcher adjusted for other factors like income, race, age, and general health, having insurance still increased the likelihood of a visit by 12 percentage points. This suggests that insurance is successfully removing a major barrier, allowing millions of people who would otherwise stay away to seek necessary treatment. Furthermore, the study found that insurance provides a powerful shield against financial stress. People with coverage were significantly less likely to say they needed dental care but could not afford it; the odds of reporting this financial barrier were cut nearly in half for the insured compared to the uninsured.
However, the study also addressed a common concern: does insurance make people spend more money than they should? If insurance simply encouraged people to get extra, unnecessary procedures, one would expect to see a sharp rise in the cost of care for those who already visit the dentist. The data did not support this. Among people who had already decided to see a dentist, those with insurance did not spend significantly more than those without it. In fact, the average spending for insured visitors was slightly lower than for uninsured visitors, though the difference was small enough that it could be due to chance. This is a crucial distinction. It suggests that the higher total spending seen among insured groups is not because they are over-consuming services, but simply because more of them are getting care in the first place. The insurance is not inflating the bill for existing patients; it is bringing new patients into the system.
The study also highlighted that while insurance helps, it does not solve every problem. Even after accounting for who has insurance, significant gaps remained in who actually gets care. Black, Hispanic, and Asian adults visited dentists at lower rates than White adults, even when they had similar incomes, insurance status, and health conditions. This indicates that factors beyond just the price of a visit, such as where dentists are located or other structural barriers, continue to limit access for many. The researcher concluded that the evidence points toward a system where dental insurance works primarily by expanding access and protecting families from financial ruin, rather than by driving up costs through unnecessary use. For policymakers considering expanding coverage to more adults, the results suggest that adding insurance is a positive step, but it must be paired with efforts to ensure there are enough dentists available to see the new patients and that the coverage is generous enough to truly remove the cost barrier. The data shows that when people can afford to go, they go, and they do not necessarily spend more just because they have a card in their pocket.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.