Broker blog from Delta Dental

Tag: dental benefits

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.

Policy pops: Health care exchanges — 2019 enrollment results

3‑minute read

Join our guest blogger, Devin McBrayer, as she reviews the outcomes of the 2019 open enrollment period for health care exchanges. Devin is a Legislative and Policy Analyst based in Sacramento, California.

The open enrollment period to purchase Affordable Care Act (ACA)-compliant individual health insurance coverage off the health insurance exchanges for 2019 has come to an end. Sign-ups were off to a slow start at the beginning of the enrollment period, leaving many experts fearful that ACA plans would experience a significant decrease in enrollment. However, total enrollment only decreased by about 3.8% nationwide on Healthcare.gov, much of this due to a 15% reduction in new sign-ups. 

While the total enrollment drop in individual health insurance plans on the exchange may have been less drastic than expected, it is still worth exploring why new enrollment decreased considerably and why year-to-year enrollment continues to decline. Several 2018 policy changes, combined with a growing economy, could help explain the decrease in enrollment in ACA plans for the 2019 plan year. 

Are policy changes to blame?

In 2018, Congress reduced the tax penalty for not having an ACA-compliant health insurance plan to zero, effectively eliminating it. The federal government also shortened the open enrollment period and reduced marketing for open enrollment. Simultaneously, the federal government passed several rules that expanded the availability of cheaper and less comprehensive insurance plans such as short-term limited duration plans. No tax penalty for lack of coverage, combined with a shorter sign-up period and more plan options outside the exchanges, may help explain the enrollment decrease.

The impact of the economy

Another possible explanation for the drop in enrollment could be attributed to an improving economy. When open enrollment started on November 1, 2018, 2 million more jobs were added to the economy than were added at the same time in 2017. As more people head back to work, it’s possible that they’re gaining access to employer-sponsored health insurance, eliminating the need to renew their ACA plan. 

What does this mean for dental?

Any loss in enrollment for medical coverage also means less people enrolled in dental coverage on the exchange. (As a reminder, dental coverage is an essential health benefit for children but not for adults.) 

In the exchanges, dental coverage is included in some health plans or consumers can get a stand-alone dental plan and pay a separate premium. However, there is no way for consumers to purchase a stand-alone dental plan without also purchasing a medical plan on the health care exchange. Pushing for states and the federal government to allow for the independent purchase of stand-alone dental plans on state and federal health insurance exchanges is a top priority for the Public & Government Affairs team at Delta Dental.

For more thought leadership from Delta Dental, subscribe to Insider Update, our newsletter for brokers, agents and consultants.

If you’re a benefits decision maker, administrator or HR professional, subscribe to our group newsletter, Word of Mouth.

Policy pops: Midterm elections’ impact on Medicaid (and dental) expansion

3‑minute read

Join our guest blogger, Devin McBrayer, as she explores the role of Medicaid expansion in the midterm elections and the potential impact on low-income adults’ access to dental benefits. Devin is a legislative and policy analyst based in Sacramento, California.

Midterm elections are just around the corner on November 6, and the results of the election could change the future of Medicaid in several states. Medicaid expansion is an important platform issue for some contested governors’ races as well as the subject of several ballot initiatives across the country. If more states expand Medicaid coverage for adults through the Affordable Care Act (ACA), dental coverage for low-income adults could also grow.

Currently, 33 states, plus Washington D.C., have opted to expand Medicaid, and 14 states have chosen not to do so. Three states, Idaho, Nebraska and Utah, will vote on Medicaid expansion for the first time this Election Day. If these states vote to expand their Medicaid programs, an additional 300,000 low-income Americans would be eligible for coverage. Montana also has a ballot initiative to extend their temporary expansion that covers 100,000 people in the state. Unless Montana voters approve the ballot initiative, the temporary expansion of Medicaid will end in 2019.

Several hotly-contested races for governor also feature Medicaid expansion as a central issue for candidates. Florida, Georgia, Kansas and Wisconsin all have Democratic gubernatorial candidates interested in expanding Medicaid if elected. Medicaid expansion could open the doors to providing more extensive dental benefits for those states’ adult populations in the future. Florida and Georgia’s current state Medicaid programs, in particular, offer emergency-only adult dental benefits, which are most often limited to pain relief under very specific situations.

Most states offer a limited dental benefit to their adult Medicaid population, but since adult dental is not a required benefit and the state must pay the entire cost of providing the benefit, fewer than half of states offer an extensive adult dental benefit. In FY 2018, 19 Medicaid expansion states chose to enhance the covered benefits in their Medicaid program, and three of those states, Arizona, California and Utah, chose specifically to enhance the dental benefit or access to dental services.

Along with the impact of elections on Medicaid expansion, it’s important to have an eye on the economic conditions. States that expanded their Medicaid programs in 2014–2016 received a 100% funding match from the federal government for newly eligible Medicaid enrollees. However, this federal match has begun to phase down and by 2020 the match will drop to 90%, which will force states to finance a greater share of the costs of Medicaid expansion. Delta Dental will continue to monitor these important elections and other trends that could have big impacts on low-income adults’ access to dental benefits across the country.

For more thought leadership from Delta Dental, subscribe to Insider Update, our newsletter for brokers, agents and consultants.

If you’re a benefits decision maker, administrator or HR professional, subscribe to our group newsletter, Word of Mouth.

Not-so-breaking news you (and your clients) need to consider

Dental care matters, and some oral health data may surprise you.

We’ve said it before, but we’ll say it again — dental care, and coverage for such care, is really, really important. Here are just a few things to think about:

There are about 74 million reasons why you should critically consider the value of dental coverage.

The number of people in the United States without dental coverage more than doubles the number of people without medical coverage. Why?

We’ve illustrated before that dental benefits are generally worth the premium. Additionally, dental coverage can provide value and protection within its own limits. According to the National Association of Dental Plans (NADP), only about 10% of people with dental coverage hit their annual maximum.

So why recommend purchasing dental coverage? 

Consider the 6% rise in employee absenteeism due to children’s oral health. A 2017 survey conducted by Delta Dental Plans Association* reveals that nearly half — 45% — of parents in the United States cite their children’s oral health issues for missed time at work.

And still more concerning, 738,000 people go to the emergency room each year for oral health issues. More people go to the ER each year for oral health issues than the entire population of Seattle, WA.

The preventive nature of dental coverage could deliver more than peace of mind for your clients, with less time and money spent on emergency care and less missed time at work. 

 

* Our enterprise includes Delta Dental of California, Delta Dental of New York, Inc., Delta Dental of Pennsylvania, Delta Dental Insurance Company and our affiliated companies. All of our companies are members, or affiliates of members, of the Delta Dental Plans Association, a network of 39 Delta Dental companies that together provide dental coverage to nearly 76 million people in the U.S.

What you should know about exchange dental benefits

It’s the fourth year of open enrollment on the public health care exchanges, and your clients probably still look to you to help them navigate the new marketplace.

Find the right exchange dental plans for your individual or small business clients by evaluating the pros and cons of stand-alone dental coverage.

Pediatric dental benefits embedded in a medical plan are often subject to high deductibles (except in California).

Dental expenses in such plans usually aren’t covered until a combined medical-dental deductible (often in the thousands of dollars) is met. Check the plan’s details to determine if certain categories of dental services are waived from the deductible. In a stand-alone plan, certification requirements ensure that only a small deductible, if any, must first be satisfied.

Stand-alone dental coverage is typically worth the premium—even if enrollees only go for twice a year exams, x‑rays and cleanings.

The premium for a stand-alone HMO dental plan usually costs less than two checkups at the dentist each year without insurance. PPO dental coverage costs more, but can still pay for itself with just two visits per year. With both types of dental plans, cleanings, exams and x‑rays are often covered at 100% or no copay. If more expensive care is needed, the cost savings only grow from there.

Individuals enrolled in a stand-alone dental plan can clearly benefit from cost savings and improved oral health. Small businesses, meanwhile, can offer meaningful benefits that can save employees money while meeting Affordable Care Act coverage requirements.

Want more insight? Check out the Delta Dental guide to Health Care Reform for Brokers and Consultants.

See what Delta Dental offers in your marketplace by visiting healthcare.gov or your state-based exchange.

All you need to know about utilization metrics, you learned in kindergarten

Okay, so maybe you didn’t learn everything you need to know about utilization and benefit rates in kindergarten. But you did learn that taking care of your teeth helped you stay healthy. And believe it or not, that fact is often a driving force in the world of dental benefit rates.

Claims and utilization metrics can be viewed as a measure of how well your clients’ employees have learned the “brush your teeth” lesson. They can also play a big role in dental benefit pricing. In order for your clients to balance their benefits costs while offering their employees the best benefits possible, it really comes down to a few basic concepts.

1. Numbers

How are their employees using their benefits? Are most of them visiting for checkups and cleanings, or is there a high number of employees that are visiting the dentist  to treat cavities, periodontal disease or other dental conditions? These numbers represent their utilization of the dental plan.

2. Patterns

By identifying trends, you assist your clients in evaluating their plan performance and making adjustments if necessary. If they have unfavorable utilization patterns, can you help them turn this around by encouraging their enrollees to get preventive care? Should you recommend a change in plan design?  (Hint: Delta Dental can help!)

3. Comparisons

Talk to your clients about how their numbers stack up to carrier and industry benchmarks. These comparisons are an additional factor in determining their rates for new coverage and renewals.

Sounds simple, right? Not exactly. There are a variety of numbers, patterns and benchmarking data to be considered – all of which can affect rates.

And that’s just the beginning. Turns out it’s complicated – maybe it’s not so easy that a kindergartner could understand it. But by working with your clients to make sense of it all, you can help them create strategies that promote savings and happy, healthy employees.

Delta Dental offers comprehensive and easy-to-use reporting to help your clients maximize their benefit dollars.

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