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Massive Changes Predicted For Dental Benefits Markets

April 05, 2013

By: Mary T. Dooley, DDS, Chairman, VDA Dental Benefits Committee

Orginally printed in the Virginia Dental Journal Vol 90 #2 April-June 2013

The National Association of Dental Plans is preparing for dental markets to shift dramatically from an employer-based to a direct-to-consumer model.   A seminar presented last November by Careington Dental Solutions discussed many trends which are driving this change. Due to health care reform, large companies are moving employees to private exchanges.  Employers are increasingly offering only voluntary dental benefits which many will not purchase, while other employers are decreasing their contributions to employer/shared funded plans. They stated that dental insurance premiums are increasing faster than medical premiums, and that the number of DPPOs  is increasing as dental indemnity decreases. Retiring baby-boomers, estimated at 44 million, will lose their employer-funded dental benefits.  Increasing awareness of the need for dental health is expected to lead to a demand for affordable plans.  

The number of Americans without dental insurance is projected to go from 133 million to 221 million.
This seminar presented their best products for this direct-to-consumer market, and how to promote it. They offered the following  solutions:  Discount plans, Hybrid plans, Affordable individual products, Flexible Savings Accounts, Pre-paid debit cards, Plans for retirees and those on Medicare, Pediatric with Discount Adult plan, and Bundling Dental with other health-related products and travel and leisure/financial services.

An example model for a voluntary employer with minimum 20%  enrollment, combines some insured benefits with discounts on non-covered services.  An Affordable Individual product example would re-price a porcelain crown to $660 dentist fee, insurance will pay $450 and out-of-pocket will be $210.  A Hybrid plan would reduce benefit to only $100 and increase patient out of pocket to $560.  Hybrid example #2 would re-price the dentist fee of $240 for an exam, 4BWX and prophy to $120, with a plan benefit of $100 and patient cost of $20. 

To seek and create positive press is the number one step in the promotion plan.  Positive press is being created online where Brighter.com compares “dentist fees” and reputations with access to discount networks.  DentalPlans.com and iDental.com also offer many different plans said to be specific to your zip code.   If you have not heard of these plans or sites, or don’t know much of what they propose, please take a couple of minutes to review online what they have in store for your zip code.  I believe it is important to know the details of what others are planning for us.