Out-of-pocket dental spending and catastrophic dental expenditures among adults with and without dental coverage in the United States

Introduction: Out-of-pocket payments create the largest financial barrier to dental care in the United States, where dental benefits are separate from medical insurance and coverage is incomplete. This study quantified out-of-pocket dental expenditures and catastrophic dental spending among US adults by dental coverage status. Methods: Cross-sectional analysis of the 2023 Medical Expenditure Panel Survey Household Component (full-year consolidated file HC-251 and dental visits file HC-248B) among 14,768 adults aged 18 years or older, using survey weights, strata and primary sampling units. Catastrophic dental spending was defined as out-of-pocket dental spending of at least 10% of annual family income, with sensitivity thresholds of 5% and 20%. Results: Dental coverage reached 52.1% of adults. Any dental visit was reported by 53.2% of adults with coverage and 34.0% without. Among adults with a visit, mean out-of-pocket dental spending was $413 with coverage and $606 without (adjusted geometric mean ratio 0.77, 95% CI 0.68-0.88). Catastrophic spending at the 10% threshold affected 0.4% of adults with coverage and 0.7% without; the unadjusted odds ratio was 0.58 (95% CI 0.37-0.93) and the adjusted odds ratio was 1.21 (95% CI 0.64-2.27). Conclusions: Dental coverage is associated with higher utilization and lower out-of-pocket spending among users, but the protective association with catastrophic spending is explained by income and disappears after adjustment, indicating that poverty rather than coverage drives catastrophic dental burden.