1950s style benefits need more bite
BY JILL KOHLER
Now is the time for traditional cost-sharing dental insurance plans to be upgraded and for the insurance industry to realize that oral care is healthcare. The standard 100/80/50 plan design with the usual $1,000 to $2,000 annual maximum has not changed since the inception of dental insurance in the 1950s. There have been major advancements in oral health technology and science over the past few decades, but dental plan designs remain in the 20th century. Our healthcare system further segregates medical and dental care, creating a silent epidemic of diseases that could be detected during an oral examination — potentially saving hundreds of millions of dollars in unnecessary comorbidity costs.
Dental is often the part of a company’s employee benefit program and wellness strategy that is overlooked. This begs the question, “How can the insurance industry change its philosophy toward dental coverage to improve the benefits while providing the plans their employees want, need and value since oral care is part of their overall health?” The answer is: through innovative dental plans and broker-client education.
Companies do not need to settle for the plain, vanilla dental coverage of the past and can offer innovative plans that include some of the following options:
- A dental plan that increases the coinsurance overtime for Type 2 and/or 3 services when the employee goes in for their preventive services at least once a year. The traditional 80% for Type 2 could increase up to 100%.
- Creating a Type 4 (Specialty) tier that carves out Implants or Crowns at a higher coinsurance amount than the traditional 50% to lower member out of pocket expenses.
- Rolling-over benefits that allow members to use the unused portion of the dental maximums towards orthodontia, vision, LASIK, and hearing benefits.
- Excluding Type 1 (Preventative) services from applying towards the annual maximum. This will allow members to use their entire maximum toward Type 2 (Basic) and 3 (Major) services.
- Coverage that allows members to use a portion of the dental annual maximum toward eye care needs. This is an excellent option since according to the National Association of Dental Plans only 2.8% of members use their entire annual dental maximum ($1,000 average) annually leaving money on the table that could go toward stylish frames or extra contacts.A recent American Dental Association (ADA) survey revealed that 95% of Americans regard their oral health as an important part of their well-being. It is one reason the national dental care expenditures in 2020 amounted to $142.4 billion (about $440 per person in the U.S.) and that 156 million Americans signed up
for dental insurance according to the National Association of Dental Plans. All signs point to the importance of dental coverage to our health. Yet, it continues to get the rap of being an “ancillary” plan. It is second to medical coverage among the insurance industry and companies, even though we know dental (and vision) are part of a person’s overall wellness.
Like other areas of the body, your mouth teems with bacteria. Most are harmless but your mouth is the entry point to your digestive and respiratory tracts, and some of these bacteria can cause disease. According to the U.S. Department of Health and Human Services, the lack of interoperability between medical and dental records further segments overall healthcare delivery.
During a dental exam, your dentist looks for tooth decay, cavities, gum disease and other oral health problems. Dentists are also trained to detect signs of more than 100 diseases through a routine exam (such as diabetes, heart disease, certain cancers, osteoporosis, anemia, and kidney diseases to name a few). A person’s oral health is often the first indication of certain diseases and conditions that the dentist may find even before a patient goes to their medical doctor. Over 90% of diseases have symptoms that appear in the mouth first, such as ulcers, swollen or bleeding gums, dry mouth, or discolored teeth. That is the reason the American Dental Association encourages regular dental exams at least every six months. There is an abundance of information that could be useful in diagnosing and developing a treatment plan if dental was part of a holistic wellness plan.
The connections are not fully understood and are still being researched. The Mayo Clinic reports that the following comorbidities are related to oral health:
- Heart disease, clogged arteries and stroke may be linked to inflammation and infection from oral bacteria.
- Periodontitis is linked to premature birth and low birth weight.
- Certain bacteria in your mouth can be pulled into your lungs, causing pneumonia and other respiratory diseases. Gum disease and Periodontitis are more frequent and severe among people with diabetes.
Change is obviously needed for dental plans that have not evolved in 70 years! Additionally, the insurance industry needs to remember that total health and wellness cannot exist without dental care since they are intricately linked. Oral disease impacts the quality of life for an individual, affecting their physical, psychological, social and economic health and well-being. Going to the dentist regularly is a major part of healthcare, especially since they can detect health issues long before someone goes to their doctor. The dentist may be the only healthcare professional an individual sees annually, further proving that dental coverage needs to become a major part of an individual and company’s wellness program. We all need to embrace the fact that oral care is healthcare and improved plan designs are needed!
JILL KOHLER is Ameritas Group Sales Representative for the San Francisco Bay Area. Kohler has been in the insurance industry for almost 30 years. She began her career while in college at California State University, Sacramento, where she earned her bachelor’s degree in Journalism. She has worked with major medical, dental, vision and voluntary benefits for small and large-size companies. She lives with her family in Northern California and works with brokers and clients through-out the San Francisco Bay Area in sales for the Ameritas benefits division.
Contact: Jill.email@example.com Mobile: 415.301.0244