By NextBestFitDental services
Adult dental is the largest new benefit. Medicaid dental fees average about 60% of private fees. Cosmetic work and adult orthodontics (about 20% of today's out-of-pocket dental spending) stay out of pocket. About 40% of adults skip dental care today because of cost, so utilization rises 35%.
Result
$238.8B
$189.2B → $238.8B
Per resident, per year
$700
÷ 341.1M people
Per household
$1,807
÷ 132.2M households
Range
$225.0B–$266.5B
Lean and costly scenarios.
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | 2024 spending on this service (CMS NHE Table 4) Sources: CMS Office of the Actuary (2025) | $189.2B | |
| 2 | Private health insurance paid $78.2B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025) | $78.2B ÷ 1.00× | $78.2B |
| 3 | Medicare paid $12.6B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025) | $12.6B ÷ 1.00× | $12.6B |
| 4 | Medicaid paid $15.2B at 0.60× the reference price → volume Sources: CMS Office of the Actuary (2025) | $15.2B ÷ 0.60× | $25.3B |
| 5 | Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025) | $72.5B | |
| 6 | Stays out of pocket (items UHP excludes: 20%) | $72.5B × 20% | $14.5B |
| 7 | Covered out-of-pocket converted to reference-price volume | ($72.5B − $14.5B) ÷ 1.15× | $50.4B |
| 8 | Care UHP takes over, valued at 2024 prices | $164.0B | |
| 9 | Same care valued at the reference price (Average 2024 private-insurance dental fee) | $166.6B | |
| 10 | Re-priced at UHP rate 0.95× | $166.6B × 0.95× | $158.2B |
| 11 | Price effect (same care, new prices) | $158.2B − $164.0B | −$5.8B |
| 12 | Utilization multiplier 1.35× | $158.2B × 1.35× | $213.6B |
| 13 | Utilization effect (more care) | $213.6B − $158.2B | $55.4B |
| 14 | UHP spending on this service | $213.6B | |
| 15 | Plus spending that stays out of pocket | $14.5B | |
| 16 | Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged) | $6.7B | |
| 17 | Plus Other third-party payers & programs (continues unchanged) | $4.0B | |
| 18 | Total national spending on this service under the plan | $213.6B + $14.5B + $10.7B | $238.8B |
| 19 | Change from 2024 | $238.8B − $189.2B | $49.6B |
Trade-off: Providers of this service receive $5.8B less for the same care; patients receive $55.4B more care.