Who Are Your “Underserved” Patients?

It can be tough getting dental care these days.

If you put yourself in the shoes of patients for just one minute, what do you see? For some (the ones with great insurance) there are few worries associated with dental care. For others, you’ll see expensive, inaccessible treatment because you’re either uninsured or the insurance you do have is next to worthless.

These patients become your “underserved.” They’re the ones you might see twice in a decade because they only show up when a dental problem becomes acute.

The thing is, for most of them, it’s not that they don’t want to come in for regular hygiene appointments. In fact, they’d love to maintain a good state of dental health. Instead, they are constrained by insurance policies or financial considerations.

For dental practices, there are often plenty of opportunities to do more to help those underserved patients, so who might these groups of people be in your community?

Need to find local demographic information? This can help!

Underserved Dental Patients

There are 115 million uninsured people in the US today. Dental insurance is often either too expensive for them or made virtually inaccessible by long wait times when they try to buy an individual plan.

If you check statistics from the CDC, they show that a large number of people are missing out on dental care—even when it is very much needed. In 2014, 10% of people across all age groups reported that they had not received needed dental care due to cost in the last 12 months.

This is probably exacerbated by the fact that 44% of dental expenses were paid out of pocket by adults in the 18 – 64 age group, more than any other type of healthcare. If they have insurance, they’re still paying a high proportion of costs. If they don’t have insurance, they’re probably too scared to even look at the cost.

The Washington Post recently reported on the “great divide” that is now seen in dental care:

“As the distance between rich and poor grows in the United States, few consequences are so overlooked as the humiliating divide in dental care.”

While wealthy Americans spend one billion dollars per year on teeth whitening, millions of others try to get into high-demand charity clinics to take care of acute problems that may have bothered them for years. In Maryland where the Post reporter visited, hundreds were queued up from the early hours of the morning, hoping to be in the first 1,000 who were guaranteed to get care at a free clinic.

Of course, oral health is a determining factor for our overall health. With so many people missing out on good, regular dental care, there is a trickle down effect for their health and the work of other health professionals. Last year, more than two million US emergency room visits were attributed to neglected teeth.

More than two million ER visits last year were attributed to neglected teeth. Click To Tweet

Of course, the majority of ERs are not equipped to deal with dental emergencies. So, as the Washington Post article discusses, doctors end up prescribing antibiotics and opioids, a cycle that is feeding a nationwide epidemic of opioid addiction.

Can dental practices play a role in changing the traditional system? We think so, but first you need to know who these underserved patients are for your practice and what their needs look like.

Here are some of the commonly underserved groups of patients we see:

Senior Citizens or Retirees

What happens to your health insurance when you retire? For many seniors, if they did have dental insurance as part of their benefits while working, this is lost when they retire. The CDC reports that this is often a worse situation for older women. Statistically, they have lower incomes and may have never had dental insurance during their working years.

About 23% of 65 to 74 year olds have severe periodontal disease, which as we know requires regular treatment or maintenance to keep under control. Aging is a big factor for taking a toll on the health of teeth, yet seniors struggle to find a solution that will suit them. An American Dental Association analysis found that the struggle is particularly painful for low-income seniors. More than a third who had incomes below 200% of the federal poverty level had untreated tooth decay.

Many end up simply having their teeth pulled, especially if they are unable to afford procedures such as root canals or crowns. Nearly one in five Americans over the age of 65 do not have a single real tooth left.

Medicare is not a sustainable solution for this group of patients either. If they get regular Medicare, dental usually isn’t covered and was not designed to cover the routine dental care needed to maintain good health. Medicare Advantage patients may have some coverage, but that is often minimal.

What about insurance? There are a few problems seniors may encounter:

  1. Insurance was designed to be sold to large groups, so trying to buy an individual plan can be fraught with wait times and complications.
  2. Many can’t afford the premiums anyway.
  3. Annual benefits are typically capped at $1,500, a figure that hasn’t changed in decades despite the fact that costs for everything (including the overheads of the dental practice) have risen. A low amount like this is easily used up on one visit.

“Gig” Workers

There’s a large (and growing) group of Americans who work within the “gig” economy. Almost 55 million people work as freelancers already and that number is predicted to grow further. It might sound like a satisfying lifestyle choice—and for some it definitely is. But for others, working on a freelance basis comes from necessity.

There has been a trend since prior to the recession of employers preferring to avoid hiring permanent staff. They get to keep their staffing costs down and often overheads too if they can hire remote-based freelancers. One of the costs they’re saving on? Paying benefits.

Gig workers have to pay all of their own benefits, a prospect that is often a struggle. For the same reasons as the seniors, they may struggle to buy individual insurance, but they’re also faced with the constraints that irregular income can bring.

When you go from gig to gig, it can be difficult to have the necessary income certainty that allows you to commit to regular costs like insurance. To add to this, seven out of ten freelancers report non-payment issues with clients, taking even more of a toll on their incomes.

You’ll find a large number of millennials in this group (more than one third of millennial workers, according to some research), but other age groups are also well-represented. Of baby boomers, 28% are part of the gig economy.


Self-employed business owners often struggle with the same issues as the gig workers. When the Washington Post visited the free clinic in Maryland, a large number of people there were self-employed and unable to afford either insurance or dentist visits. It’s difficult to prioritize dental health when you don’t yet have an acute problem and paying your basic bills takes up a lot of your focus.

Small business owners in particular fall into this group. They are often making just enough to cover bare necessities, but not enough that they feel they can buy insurance.

Employed People Without Benefits

Going back to that Maryland clinic, there were truckers, librarians, forklift drivers, and postal workers—all people who are employed but don’t have dental insurance benefits. Many jobs that used to offer good benefits no longer do as employers look for ways to cut costs.

This puts them in that same boat as others, where they’re trying to buy into a dental insurance program that was designed for groups. They might not be able to afford the cost at all, or they’re forced to wait for a year or more before they can get the insurance.
Immigrants or Limited Literacy

For new immigrants or those with limited literacy, navigating the US system of insurance can be a highly confusing experience. They may have language or cultural barriers to accessing dental care or the whole thing just feels like too much to try to unravel. This is another group of people who may fall through the cracks until they turn up with a dental emergency.

Where can you find local demographic information? Get our quick tips here.

A New Way of Doing Things…

Almost every dental practice will have underserved patients represented in their area, which is one very good reason to look at a new way of doing business. Dental practices still follow ancient models that tend to add to the “dental divide”, yet there is plenty of opportunity to serve those who we’ve talked about here.

A Health Assurance plan empowers you to create subscription levels that best suit your practice and patients, and it’s a solution that has worked well for our dental practices. The idea is that the patient can now see a way forward that is suitable for their situation, and the relationship with the dentist becomes based on a mutual bias toward good health.

No more confusing insurance requirements and the patient can actually see a benefit in the money they pay each month. It’s not disappearing into the black hole of the insurance company—it’s accounted for in treatments or hygiene visits.

There has to be a better way to ensure that everyone can access good dental care. How will you take care of underserved patients in your community?

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