Broker blog from Delta Dental

Author: Delta Dental (Page 1 of 12)

2021 Small Business Program: Networks made simpler

A new video is now available to help explain the Delta Dental PPO™ and Delta Dental Premier® networks. Designed especially for Small Business Program (SBP) clients, this video highlights the differences and similarities between these networks.

Two networks, one satisfying experience

This video will help SBP clients understand the following points about our networks:

  • Members with a Delta Dental PPO plan can see any licensed dentist.
  • Between the PPO and Premier networks, Delta Dental has the nation’s largest dental network1 — finding in-network dentists is easy.
  • Members with Delta Dental PPO plans will usually save the most when they visit a PPO dentist. For members who want to visit a Premier dentist, a Delta Dental PPO Plus Premier™ plan will help increase their savings.

Stay tuned for more updates on our 2021 SBP portfolio! Looking for an overview of the SBP portfolio as a whole? We’ve got you covered.

1 Delta Dental Premier is the largest dentist network nationwide based on total unique dentists, as of March 2020, according to Zelis Network360.

5 ways Delta Dental is responding to the COVID-19 pandemic

Delta Dental is working to support our customers, dentists and local communities during the COVID-19 pandemic. Here are some of the ways we’re responding to this health and financial crisis.

1. Charitable giving to vital services

The Delta Dental Community Care Foundation has provided nearly $15 million this year to help nonprofits respond to the pandemic. These unrestricted grant funds have supported essential services, including dozens of dental and medical clinics serving low-income communities across our 15-state service area and the District of Columbia.

To help feed vulnerable communities during skyrocketing food insecurity, we’ve also contributed $2.5 million to food banks in Alabama, California, Delaware, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Texas, Utah, West Virginia and the District of Columbia.

2. Dentist loan program

Partnering with Provide (formerly known as Lendeavor), Delta Dental has offered over $300 million in loan programs to provide economic relief for qualifying independent network dentists.

The loan program, which extends through the end of the year, covers cash flow relief as well as interest savings. It also includes loans that dentists can use to acquire, refinance, expand or equip a practice, as well as to acquire or refinance commercial real estate for a practice.

3. Relief for groups, individuals and brokers

We’ve offered various forms of premium relief to all lines of our business to help alleviate the financial strain of the pandemic on our individual customers and group clients. To provide further support, we’ve made adjustments to many of our contract policies to help clients and brokers weather the financial impact of the pandemic.

At the same time, we’ve also prioritized our brokers’ financial stability. Commissions have remained intact, with no reductions to offset premium relief.

4. PPE and infection control reimbursement for dentists

The new costs of practicing during a pandemic have added to the financial strain on our network dentists. To help, Delta Dental launched a supplemental reimbursement program for network dentists.

The temporary program, which runs through the end of the year, is meant to help dentists adjust to the new conditions under COVID-19 as they plan for 2021. Under the program, network dentists receive an additional $10 per patient per qualifying service to help cover the costs of additional personal protective equipment and other infection control practices.

5. Teledentistry resources

Delta Dental has encouraged dentists and patients to consider teledentistry options for diagnostic and emergency dental services. Teledentistry, or virtual consultation via phone, text or video, offers a safe, convenient choice and can expand access to care for patients who might otherwise not see a dentist.

We’re offering discounts and free trials on HIPAA-compliant teledentistry services to Delta Dental dentists and are building partnerships with teledentistry companies to improve the experience for our customers and network dentists.

Dental implants are coming to DeltaCare USA

A new kind of large group plan is coming to DeltaCare® USA plans in 2021. Effective January 1, 2021, DeltaCare USA i‑series plans will be available with comprehensive coverage for dental implants. Once i‑series plan rollouts are complete (there will be nine in total), they will be available in all 50 states and Washington, D.C.

These plans are designed to address the growing demand for dental implants. The same outstanding features that DeltaCare USA plans are known for, like affordable prices, coverage for orthodontics and coverage for teeth whitening are all still here, too. With this updated value proposition of enhanced benefits and consistent coverage, offering DeltaCare USA is a more attractive proposition than ever before.

For more information, please contact your account manager.

The 2020 elections and the ACA: What’s at stake for dental insurance

For the dental insurance industry, the upcoming November elections are among the most important in recent history. Depending on the outcome, the Affordable Care Act (ACA) could be affected significantly, which in turn could reduce access to oral health care for millions of Americans.

What’s going on with the ACA?

The future of the ACA is in question. In the case of California v. Texas, scheduled to be heard before the United States Supreme Court on November 10, the court will decide whether the law should be struck down, and which elements may or may not be saved.

A previous Insider Update article looked at how the upcoming Supreme Court nomination might affect the fate of the ACA. We’ll now consider the potential impact of the upcoming elections.

The upcoming election: What could happen?

On November 3, U.S. voters will decide whether to reelect President Donald Trump, a Republican, or replace him with former Vice President Joe Biden, a Democrat. They’ll also decide who will fill many United States Senate and House of Representative seats. Three outcomes are possible: 

  • A clean sweep by the Democrats. Democrats gain control of the White House and Senate, and retain control of the House.
  • A partial sweep by the Democrats. Democrats gain control of the White House and retain control of the House, but Republicans keep control of the Senate.
  • A return to status quo. Republicans keep the White House and Senate, and Democrats retain control of the House.

Current polling data strongly suggests that Democrats will retain the House, so a Republican sweep is unlikely.

How could a Democratic sweep affect the dental insurance industry?

A clean sweep for the Democrats, not surprisingly, would likely preserve and strengthen the ACA, regardless of the Supreme Court’s decision on California v. Texas, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“With Democrats controlling all three branches, Congress can quickly restore almost anything the Supreme Court might strike down, and do so long before the court’s decision becomes effective,” Album said.

Beyond the ACA, industry experts predict a clean sweep could lead to many other outcomes relevant to the dental industry:

  • Medicare could become available to people younger than 65, which could open new Medicare Advantage (MA) markets in which dental is often offered.
  • A dental benefit could be added to Medicare Part B, or as separate Part “T” (for teeth). Depending on the extent of the benefit provided, a Part B dental benefit could create or eliminate opportunities for dental insurers. A comprehensive Part B benefit could replace the private dental coverage purchased by millions of Medicare beneficiaries today, give growth to dental as a part of Medi-Gap policies, and eliminate employer-sponsored retiree dental plans. However, a Part B dental benefit limited to only preventive care could create opportunities for insurers to offer supplemental benefits plans. A Part B dental benefit would also require that all Medicare Advantage plans provide at least the same set of dental benefits, which would result in these plans receiving larger payments from the U.S. Centers for Medicare & Medicaid Services (CMS). About a third of MA plans today don’t offer dental.
  • A “public option” could be created. While the Biden campaign hasn’t offered many details, a public option is conceptually a federal health insurance program to be offered on state Health Insurance Exchanges as an alternative to private plans. It would likely be subsidized for lower income Americans, and partially or fully paid by enrollees who currently don’t qualify for subsidies. While dental coverage isn’t guaranteed to be a benefit for anyone other than children, an intriguing possibility is that it could be made available on a voluntary basis.
  • The public option might even entail automatic enrollment for low-income people into an existing Medicaid managed care or Medicaid fee-for-service plan.
  • Balance billing, or “surprise billing,” by out-of-network providers could become regulated by federal law, but it’s unclear how this might affect dental benefits, if at all.

How about a partial Democratic sweep?

A partial sweep, with a Republican-controlled Senate able to prevent legislation beginning in the House from reaching the president, would likely thwart a public option, strengthening the ACA or adding dental coverage to Medicare. However, a Biden White House could preserve the ACA as it currently exists, and eliminate through executive order moves by the prior administration to weaken it.

“Dramatic change is unlikely,” Album said.

Paired with an unfavorable Supreme Court ruling, however, a partial sweep could spell trouble for the ACA, Album said.

“It makes recovering from an adverse Texas decision in the Supreme Court much harder because the Senate Republicans may support many of the cutbacks an adverse SCOTUS decision could cause,” Album said. “And should the Supreme Court strike the ACA entirely, it’s hard to imagine Democrats and Republican agreeing on replacement.”

And what if we maintain status quo?

Should the country continue with a Republican president and divided Congress, the outcome of California v. Texas is uncertain.

A ruling that either leaves the ACA in place, or finds that the law’s individual mandate can be eliminated while leaving the ACA otherwise intact, means little change. But a ruling that the ACA is inseverable from the mandate means millions will lose coverage they have today, with Congress likely unable to respond.

Album predicts that a Republican White House would probably continue to work through executive orders to weaken the ACA and make ACA-non-compliant alternatives more widely available.

The worst-case scenario for the ACA occurs if federal funding for the program is eliminated. As many as 2 million people with Exchange-based dental benefits in the Exchanges could lose that coverage. For insurers, the risk is most acute for those with sizeable managed Medicaid and Exchange business.

“Marketplace changes could be profound,” Album said.

2021 Small Business Program changes: Overview

The end of 2020 is right around the corner, and that can mean only one thing: updates to plan portfolios for 2021! In particular, big changes are coming to the Small Business Program (SBP) portfolio.

Introducing the three-level system

The biggest update to the SBP portfolio in 2021 is the new three-level plan structure. Whether Delta Dental PPO™, Delta Dental PPO Plus Premier™ or DeltaCare® USA, all plans will now be classified Deluxe, Advantage or Core.

  • Core plans offer the baseline benefits and value that Delta Dental plans are known for.
  • Advantage plans balance the value offered by Core plans with the expanded benefits and coverage of Deluxe plans.
  • Deluxe plans offer the most coverage and the highest levels of benefits without compromise.

More, more, more

Delta Dental PPO plans are getting more of the benefits and options that brokers’ clients have been asking for. These new features include:

  • More coverage for popular benefits, like white fillings in front and back teeth
  • More dual choice and Core/Buy-Up plans for clients looking for more plan options
  • More voluntary plan choices
  • More plans for groups with 2–4 employees
  • And even more!

It’s all about value

When your clients think about Delta Dental, they think of great benefits and amazing value. The changes coming in 2021 are going to make that even clearer. These plans are going to be easier to understand, feature more of the benefits your clients will love and offer coverage for more groups no matter their size.

Stay tuned for more posts with updates on our 2021 SBP portfolio!

The Supreme Court nomination and the ACA: What’s at stake for dental insurance

In the case of California v. Texas, scheduled to be heard before the United States Supreme Court on November 10, parties challenging the Affordable Care Act (ACA) seek to overturn the law as unconstitutional. What might this case mean for the future of the ACA and insurance more widely?

The usual questions surrounding the outcome of this case have been complicated by the appointment of Amy Coney Barrett, a new justice to the Supreme Court, nominated by President Donald Trump.

What’s at stake for the ACA?

The elimination of the ACA could have significant consequences, including:

  • Decreases or complete loss of state and federal Exchange enrollment, adult Medicaid enrollment and commercial enrollment of dependents up to age 26
  • A reduction or elimination of individual health insurance subsidies, which could erode Exchange enrollment
  • A reduction or elimination of dental benefits for adults in Medicaid

So what’s California v. Texas about, anyway?

The state of Texas, along with a group of other states and individual plaintiffs, is arguing that the ACA is unconstitutional. Specifically, they say that the 2017 changes to tax law, eliminating the penalty for failure to purchase health coverage, essentially eliminated the individual mandate, upon which the entire law depended.

Originally, the individual mandate required most people to have health insurance coverage. It penalized those who failed to comply by requiring them to pay a financial penalty to the IRS. The 2017 Tax Cuts and Jobs Act eliminated the financial penalty, but left the mandate in place.

The Texas-led plaintiffs argue that because the mandate no longer produces revenue for the federal government, it’s unconstitutional. Further, they say that the mandate can’t be severed from the rest of the ACA, so if the mandate is unconstitutional, the entire ACA is unconstitutional.

In December of 2018, a U.S. District Court judge in Texas agreed. In 2019, the case went to the U.S. Court of Appeals for the Fifth Circuit. That court agreed with the District Court’s decision that the mandate was unconstitutional, but didn’t rule on whether the mandate was inseverable. 

On the other side, California, together with a group of 18 other states, is defending the ACA.

In an unusual move, the federal government is siding with Texas, though offering arguments to allow some elements of the ACA to continue.

The Supreme Court has agreed to hear the case, scheduled for November 10. It will decide whether the Texas case has merit, whether the mandate is unconstitutional and, if so, whether this invalidates the entire ACA, or whether to let lower courts rule on severability.

Why a new Supreme Court justice matters

Justice Amy Coney Barrett has been confirmed and will fill a vacant seat on the Supreme Court. 

Barrett was formerly a circuit judge on the U.S. Court of Appeals for the Seventh Circuit. She’s considered a political conservative and constitutional originalist, which means she believes the U.S. Constitution should be interpreted as it was understood at the time it was written. As a judge, she has also ruled against the ACA in the past. She replaces Justice Ruth Bader Ginsburg, known for being one of the Supreme Court’s most liberal justices.

What specifically Barrett’s confirmation means in terms of a ruling is unclear, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“We’re not sure how the conservative judges are going to hear this particular case,” Album said. “Conservatives are thought to be originalists or strict interpretationists, and if they were truly to follow an originalist philosophy, striking the entirety of the ACA is not consistent with that.”

That’s because, Album said, if Congress had intended to overturn the ACA, the 2017 tax cut bill would have explicitly called for such an overturn, and the merits of that debated openly in hearings. That this didn’t happen speaks to the intent of Congress, which is an important consideration for a Supreme Court reaching a decision based on originalist thinking.

“Strict interpretationists are loath to reverse an act of Congress,” Album said. “They don’t want to counter Congressional intent, and they certainly don’t want to legislate from the bench. And if you listen to remarks that Amy Barrett has been making in the hearings, she’s gone out of her way to say she doesn’t believe that it’s a judges’ job to do anything other than enforce the Constitution and enforce the law.”

Still, that’s not a guarantee that Barrett will rule to preserve the ACA, Album said.

“We know that Amy Barrett is not fond of the ACA,” Album said. “She’s ruled against it many times, so she already has that track record.”

So what if the ACA is struck down? Then what?

If the Supreme Court rules to strike the entire bill, the impacts are “going to be profound,” Album said.

In that scenario, blue states such as California, New York, Massachusetts and Maryland would pass state laws to attempt to preserve some elements of the ACA, Album said, but they might lack federal support for the subsidies people depend on to afford those programs. Few red states, meanwhile, would be prepared to run their own Exchanges without the federally facilitated marketplace. This could lead to enrollment in Exchanges dropping substantially, Album said.

And this could lead to substantial enrollment declines for insurance companies with sizeable managed Medicaid and Exchange business.

About 1.9 million adults who have purchased optional, non-subsidized dental benefits in the Exchanges could lose their coverage. Young adults between the ages of 19 and 26 who were added to commercial employer coverage as a result of the ACA will lose that coverage if the ACA is completely struck.

Congress could decide to provide relief, but its ability to do so is dependent on the results of the November election. We’ll take a closer look at what the election results could mean for these issues in an upcoming article.

However…

Regardless of what happens, Album said, don’t expect anything to happen any time soon. Following the California v. Texas hearing in November, the decision won’t be announced until April or May, and possibly as late as June.

And if the Court agrees that the mandate is severable and sends that question back down to the lower courts, it could take years before that outcome and the additional legal challenges it will face.

A final twist is that while the current administration is arguing that the mandate should be struck down, it’s also urging that lower courts rule which provisions should and shouldn’t be invalidated.

“Even the Trump administration has suggested, and perhaps will argue in the Supreme Court, that some things should be left alone,” Album said. “We just don’t know which things they would cherry-pick in terms of what should be inseverable and what shouldn’t.”

Note: This post was updated to note Barrett’s confirmation to the Supreme Court on October 26.

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