Broker blog from Delta Dental

Category: Industry and policy (Page 1 of 4)

Find in-depth policy analysis and the latest on industry news.

How are dentists recovering from the pandemic?

In the months since the coronavirus (COVID-19) pandemic entered the United States, the future of the dental industry has been on relatively shaky footing. But despite fluctuating patient volumes, lower than normal dental spending and large-scale coverage losses across the country, outlooks for the future are looking positive as recovery from the pandemic gains momentum.

Patient volumes are increasing

For the first time since late March 2020, slightly more than 50% of dental practices are open with pre-pandemic patient volumes, according to the American Dental Association (ADA)’s report COVID-19: Economic Impact on Dental Practices, Week of March 15. With less than 1% of practices fully closed, over 99% of practices are now open and seeing patients.

A year ago, during the week of March 23, 2020, the ADA reported that 19% of practices were fully closed and 76% of practices were only seeing emergency patients. In the following months, practices began to reopen and saw slow but steady increases in patient volumes. By late August, almost half of practices were open with normal patient volumes. That percentage dipped down again in November, but slightly more than half of practices are now operating at their pre-pandemic levels.

Due to cancellations during the second and third quarters, many practices saw holes in their schedules during the fourth quarter of 2020 and the first quarter of 2021. Usually, a practice would have 80% or more of its schedule filled. The past year was much different, with the average schedule only 50% full. This dip occurred in part because some appointments in the first half of 2020 were cancelled due to the pandemic and then the appointments were not immediately rescheduled.

In good news, nearly three in every four patients believe that routine dental appointments are still important during the pandemic, according to a September 2020 survey by the Delta Dental Institute. Most respondents said they were worried about the long-term side effects of missing appointments. The results of this survey may suggest that patients will continue to return to dentists.

Dental care spending dipped in 2020

The dip in patient volume also a contributed to a projected dip in yearly dental spending. The ADA’s Health Policy Institute predicted in its June 2020 industry model that dental care spending would dip by up to 38% in 2020 and 20% in 2021. Their models didn’t take into account additional waves of COVID-19 cases. However, dental spending in 2020 dropped by 20%, a large drop but significantly less than the amount predicted by the ADA.

Compared to other health services, dental services had the largest decline in spending, possibly related to practice closures and patient anxieties about infection while receiving care.

Changes in coverage may have contributed to decline

Disruptions of the job market and financial instability caused by the pandemic have altered the insurance market. Almost 7.7 million workers with employer sponsored insurance (ESI) lost their coverage due to the pandemic. An additional 6.9 million dependents lost their insurance coverage when their family members lost jobs.

In the past year, 39% of Americans have chosen to reduce or eliminate their insurance for financial reasons. Some people see dental insurance as an additional cost that isn’t worth it when their oral health is currently good or their dentist isn’t in-network.

The strong link between employment and health insurance coverage has important implications for Americans’ insurance coverage and access to health care, as ESI is the most common form of health insurance in the United States. It’s also crucial that patients understand the connection between oral health and overall health as they make choices about their coverage.

Low risk of infection in dental practices

Despite dentistry being flagged as a high-risk profession for COVID-19 infections, the estimated rate of COVID-19 cases among dentists was less than 1%, according to a November 2020 study in JADA. Low rates of infection, about 3%, were identified in dental hygienists as well, according to a study published in the February 2021 issue of The Journal of Dental Hygiene.

These statistics suggest that enhanced infection control measures implemented by almost 99% of practices helped prevent infections in dental settings. Low rates of infections paired with the fact that nearly 80% of dentists have now received at least one dose of a COVID-19 vaccine, dental practices are very safe for patients and staff.

Positive outlooks for the future

There’s a bright light at the end of this long tunnel. About 44.9 million people have been fully vaccinated in the US and an additional 82.7 million people have received at least one dose of a COVID-19 vaccination. A large push to have enough vaccine doses for every American by May 1 may contribute to higher patient volumes in the second half of 2021. Additionally, 70% of Americans intend to get vaccinated or already are. Economic supplements and stabilizers from the federal government will potentially ease stress for some Americans who may be avoiding appointments for financial reasons. With fears of COVID-19 infection at the dentist easing, the future is looking bright for dentists who want patients back in their chairs.

The 2020 elections and the Democrats’ clean sweep: What’s at stake for dental insurance

In an earlier Insider Update article, we considered three possible outcomes of the 2020 United States elections and some possible implications of each.

Since then, the Democratic Party has gained control of the Senate, while winning the White House and keeping control (just barely) of the House of Representatives.

From the Delta Dental perspective, this “clean sweep” impacts all our stakeholders, including dentists, enrollees and our group customers. What follows are some potential opportunities and challenges that may affect you.

The Affordable Care Act (ACA) and the health insurance marketplace (exchange) system will be preserved and expanded

President Joe Biden’s administration has made restoring the ACA an immediate priority, and many of the cuts and restrictions imposed by the administration of former President Donald Trump are being reversed.

This is a positive development for the dental industry, said Jeff Album, Vice President of Public & Government Affairs for Delta Dental.

“News that’s good for the ACA and good for the exchanges is good news for the industry,” Album said. “This market and the increased subsidies attract people who wouldn’t otherwise get insurance.”

Among the ACA-related actions that are either underway or soon to happen under this administration:

A special enrollment period to increase exchange enrollment is officially underway

Biden signed an executive order to create a special enrollment period from February 15, 2021 through May 15, 2021, during which eligible people can enroll in coverage from the federal health insurance marketplace. Uninsured residents in the 36 states that use the federal exchange system, including those who lost coverage because of the pandemic, can look for plans.

States with their own marketplaces are also creating special enrollment periods, although the time frames and eligibility requirements may differ.

The Centers for Medicare & Medicaid Services (CMS) has earmarked $50 million for outreach and education during the enrollment period.

The ACA’s Navigator Program will return

Reversing the prior administration’s move to defund this program, CMS will now provide about $2.3 million to help people find coverage on the federal exchanges, a process that can be confusing. The money will fund 30 Navigator Programs in 28 states. This, Album said, should help bolster dental enrollment.

“Several studies suggests that consumers are completely unaware of marketplace open enrollment dates, including the special enrollment periods,” Album said. “We believe this type of outreach will definitely help promote adult dental voluntary enrollment.”

Subsidies for exchanges will increase

The $1.9 trillion American Rescue Plan Act of 2021 (ARP), which Biden signed into law on March 11, includes increases to ACA subsidies. Consumers with household income more than 400% the federal poverty threshold (about $51,000 per year) will receive federal assistance to ensure that no more than 8.5% of their income goes toward a plan.

“The subsidies are getting better and the Biden administration is trying to bring more people into the exchanges,” Album said. “A great many small business and individuals impacted by the economy and COVID will now have an opportunity to get exchange-based dental coverage.”

Waivers that allow states to circumvent exchanges may be eliminated

Section 1332 of the ACA permits states to apply for a waiver to pursue “innovative strategies” to provide their residents with access to affordable health insurance, so long as they retain the basic protections of the ACA.

However, in 2020, the state of Georgia used the 1332 waiver to effectively eliminate its exchange program and force Georgia residents to purchase plans from private insurers without any kind of centralized platform. As a result, Biden directed federal agencies to reexamine all waiver policies, including 1332.

“I think this administration is going to be tougher than the former one when it comes to deviating from the ACA’s framework,” Album said. “We’re not likely to see any other states attempt a direct enrollment alternative to centralized state-based exchanges or the federally facilitated exchange.”

Medicaid eligibility under the ACA will expand

The ARP also includes incentives to encourage states to expand Medicaid eligibility under the ACA. States that choose to expand would receive a 5‑percentage-point increase in Federal Medical Assistance Percentage (FMAP) payments to current Medicaid enrollees.

“The FMAP increases are important because that’s what allows states to do optional benefits like adult dental,” Album said. “Here in California, the adult dental Medicaid program was going to be in trouble if the state didn’t receive more financial assistance.”

A “public option” with a dental benefit could be created — but probably won’t

A public option would be a federal health insurance program offered on states’ exchanges as an alternative to private plans. It would probably be subsidized for lower income Americans and at least partially paid for by enrollees who don’t qualify for subsidies.

While dental coverage wouldn’t be a guaranteed benefit for anyone other than children, it could be made available on a voluntary basis.

Initially, it seemed as though a clean sweep by the Democrats would almost guarantee a public option. Candidate Biden repeatedly said he supported it during his 2020 campaign. And California Attorney General Xavier Becerra, Biden’s pick for Secretary of the U.S. Department of Health and Human Services and a long-time proponent single payer health care, said during a recent Senate hearing that he would support Biden’s efforts to do so.

However, the Democratic sweep in the 2020 election might not be enough to push this through. Despite their control of the Senate, the Democrats depend on the tie-breaking vote of Vice President Kamala Harris. Furthermore, the Democratic majority in the House narrowed significantly, which increases the leverage of moderate Democrats who aren’t enamored with the public option.

“Given the Democrats’ razor-thin majority in both the Senate and the House, and Republican opposition to the concept, a public option currently seems unlikely,” Album said. “I don’t see it happening.”

Leaving the ACA, here are a few other possible issues likely to come up for Congress and the new administration to consider that may potentially impact dental insurance.

A dental benefit could be added to Medicare

Democrats in the House and Senate have introduced bills to add dental under Medicare Part B. As introduced, these bills do not specify which benefits should be added, which makes it difficult to assess whether the proposals help or hurt existing Medicare Advantage dental plans.

“Neither the House nor the Senate is likely to take these bills up in earnest until the latter half of the year,” Album said, “but our goal will be to participate in discussions yet to come on how the industry can help facilitate bringing dental care to seniors without disrupting existing, successful programs.”

Questions remain

As with any new administration, there are more questions than answers at this point, and how — or if — some of these proposed changes will be implemented is uncertain. What is certain, however, is that we can expect more proposals and policy updates that will affect the dental insurance industry in the upcoming months. Be sure to refer back to Insider Update for news and updates as they become available.

Pediatric dentistry trends in 2021: How COVID-19 has affected children’s oral health

From work to school to every errand in between, the pandemic has affected just about every aspect of daily life, and as we’ve heard over and over again, children are struggling to keep up. As NBC News reports, grades are slipping and absenteeism is soaring. Sadly, and perhaps unsurprisingly, that absenteeism has also surfaced in other cornerstones of child development, including basic health care checkups.

Dropping numbers

Pediatric dental services were down 69% between March and May of 2020 year over year, according to the Centers for Medicare & Medicaid Services. During this time, of course, many practices had temporarily closed their doors. The numbers began to bounce back in May but are still lower than average. Delta Dental of California and its affiliates saw nearly a 10% drop in enrollees between the ages of 3 and 18 receiving exams or dental service from 2019 to 2020.

So, why the low turnout? A few reasons:

  • Apprehensions due to the pandemic. Perhaps the most obvious answer here, but a significant factor, nonetheless. Despite the many precautions taken by health professionals, some parents are still uncomfortable leaving their bubbles just yet. A majority of Americans spent the 2020 portion of the pandemic fearful of contracting the virus, according to a YouGov study. For at-risk parents with few other options, skipping out on these errands can be their only choice.
  • Limited options. With months of closures and capacities limited, simply securing an appointment can be difficult, never mind one at a convenient time. Balancing a home that is suddenly now an office and a school can leave few options for exhausted parents to get their children in the dentist’s chair. Additionally, needed care that might’ve been detected in a school clinic setting may go unnoticed with so many schools still closed. Medicaid beneficiaries are even more likely to struggle with these limitations, according to a poll by C.S. Mott Children’s Hospital at the University of Michigan.
  • Low priority. While small dental procedures are sometimes seen as easy to put off for children who still have baby teeth, there can be long-term effects. Left untreated, cavities can turn to abscesses or hinder the growth of healthy adult teeth.
  • Socioeconomic status. Perhaps the most concerning trend, however, is that of the deepening inequities in health care. The number of children without insurance hit a historic high in 2016 – well before the pandemic hit – and has continued to rise steadily since then, according to a study by Georgetown University. The pandemic, of course, has only exacerbated these issues.

Health care and wealth gaps

As the wealth and health care gap widens due to the pandemic, so do the many ways that such disparities trickle down to the nation’s children. According to the Journal of the American Dental Association, some of the biggest setbacks include:

  • Food deserts. Lack of healthy food options disproportionately affects low-income communities and nearly half of all students rely on free or reduced-price lunches. With schools closed, many families are forced to choose cheap and unhealthy options
  • Unprecedented job loss. With unemployment on the rise, so is lack of insurance or gaps in coverage. For unemployed or underemployed parents, losing employer sponsored coverage can mean unaffordable out-of-pocket costs for themselves and their children. Roughly 6.3% of the U.S. population remains unemployed, as reported in February 2021 by the Bureau of Labor Statistics.
  • Vicious cycle. A 2020 study by the Journal of Dental Research indicated that nearly half of the people who lost dental insurance during the pandemic will likely remain uninsured. This number is estimated to be even higher in states without Medicaid expansion.

Delta Dental and pediatric care

Delta Dental has been making strides to improve health and give back to our young and at-risk neighbors. In 2019, the Delta Dental Community Care Foundation provided nearly $20 million in funding to community organizations ranging from health centers to food banks. Many of the grant recipients are focused on pediatric health, including the Children’s Medical Center Foundation in Dallas, Texas, Family Health Centers of Southwest Florida in Ft Myers, Florida and Healthy Smiles for Kids (HSK) of Orange County, California.

In 2019, the Foundation funded a program through HSK called Prevention, Outreach, Education and Teledentistry (POET), which helps kids receive a comprehensive six-month dental check-up at their school, pediatric office or community sites. With this funding, the program was able to care for more than 25,000 underserved children.

Additionally, Delta Dental launched new teledentistry options this year, including an app called Toothpic. The program is intended to help patients, especially those struggling to make appointments, such as busy parents, get advice from a licensed dentist without leaving home or having to make a real-time appointment. With Toothpic, users simply answer a few questions and snap a photo of problem area. Within 24 hours, they’ll receive custom advice that includes options, costs and information on where they can find a Delta Dental dentist.

What’s next

The good news is that unemployment numbers are gradually dropping while COVID-19 vaccinations steadily rise. While this past year’s statistics may feel somber, they don’t have to be the final word. Affordable health care options like Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for children, are more important than ever, as is education about the importance of dental health.

A quick look at people without dental insurance

In 2019, there were almost 74 million people, or nearly 25% of Americans, without dental insurance in the United States. At the height of the unemployment rate’s rise, coronavirus-related job losses and cutbacks left more than 16 million people without dental insurance from an employer. Some of that population will either purchase individual dental coverage, or else find coverage through government plans, but the number of individuals without dental insurance is still expected to increase to as many as 82 million individuals.

Let’s take a closer look at this growing market.

Who are the uninsured?

When examining the 2019 enrollment survey by the National Association of Dental Plans, there are two qualities that jump out when looking at the average uninsured individual.

The first is that people without dental insurance tend to be older than the average American, with an average age of 53.

Second, the uninsured are more likely to be women. Women make up 66% of the uninsured population in America.

Beyond that, the uninsured are a fairly diverse group.

  • Compared to the general population, the uninsured are less likely to be working full-time,with 40% employed and 40% retired. The remaining 20% are unemployed or not working by choice.
  • The uninsured are more likely to be non-Hispanic whites than the general population, at nearly 80% compared to 60.7% for the general population.
  • More than a quarter have children under age 26 at home. Over 40% of the general population has children in this age group at home, so the uninsured are less likely to have children at home than the general population.
  • More than half have some college education. The gap between the uninsured and the general population is very small here. As a whole, just over 50% of Americans over 25 have a bachelor’s degree or higher.
  • More than half of the uninsured are married or in a domestic partnership. A little less than a quarter are single, and the remainder are divorced or widowed.

Why don’t people have dental insurance?

One reason why the uninsured don’t have coverage may have to do with the high average age of the group. They may be retired or reliant on Medicare for insurance, and only Medicare C plans may cover dental. For these individuals, remind them of the low monthly cost of premiums and the size of Delta Dental’s network to help them see that dental coverage is both affordable on a fixed income and easy to access.

There may also be a general lack of information, particularly among those who are retired or jobless and don’t have a benefits administrator to curate plans. Share resources such as Grin! to help them understand why dental coverage is important and what their options are.

Some of the uninsured may have chosen to not have dental insurance, especially if they’ve been looking to cut costs due to changes in their employment status. Over the past year, 39% of Americans reduced or eliminated their insurance for financial reasons, according to Dentistry Today. Of those who have been furloughed or laid off because of COVID-19, this number jumps to 65%.

Common reasons given for choosing not to have insurance include:

  • “My oral health is already good, and I don’t need to visit the dentist.”
  • “Dental insurance isn’t worth the money. I’d rather pay out of pocket.”
  • “I don’t have insurance, because I use a flex spending or health savings account to cover costs.”
  • “The dentist I see isn’t in the insurance network anyway.”

Sharing information about the benefits of dental insurance, even in times of economic uncertainty and the coronavirus pandemic, may help persuade these individuals. You can also remind them that having insurance can be worthwhile because it makes it easier to keep dependents covered, including some adult children.

COVID-19 and the uninsured

The disruptions caused by COVID-19 have affected the uninsured population especially hard. Without insurance to help catch issues early, the uninsured are more likely to have untreated oral health issues and other problems. People with oral health issues and chronic diseases are at higher risk of hospitalization from COVID-19, according to the Centers for Disease Control and Prevention. Having and using dental insurance can help lower the risk of serious complications from COVID-19.

Given that the uninsured population is more likely to be vulnerable to costly dental bills, inadequate dental care and experiencing health issues that go alongside poor oral health, dental coverage is more important than ever before.

Why companies need ancillary benefits

Dentist documents findings during an exam with patient.

By offering companies a way to enhance their employee benefit package, you are providing them a marketplace advantage for retaining a motivated, healthy workforce.

Nearly 60% of responding hiring managers, human resources professionals and workers identified better benefits as a key strategy to strengthen connections with employees and reduce turnover, according to a 2018 Career Builder survey. To achieve this goal, companies are looking to add ancillary benefits.

What are ancillary benefits?

An ancillary benefit covers a specific need not addressed by the group medical insurance plan. Dental, vision, life, disability and even pet insurance are complementary products that can be integrated into company benefit packages.

This is how companies can strengthen connections with their employees. Ancillary benefits deliver value through access to health care plans and financial solutions that enhance total wellness, lower out-of-pocket expenses and give peace of mind.

What is the value of an ancillary benefit?

Through ancillary benefits, companies show that their priorities match employees’ priorities. According to an American Dental Association survey, 30% of young adults have tooth decay, 35% reported difficulty biting or chewing and feeling embarrassment at the condition of their teeth and 59% of respondents reported cost as the top reason for not visiting the dentist. 

Companies saved $5.8 billion over four years by offering stand-along vision plans, according to a study by the HCMS Group. Widespread computer use can lead to digital eye strain, and plans generally include coverage for a comprehensive eye exam, contact lenses or glasses, and allowances for LASIK or PRK refractive surgery.

Although 75% of millennials don’t carry life insurance, this benefit becomes more important to them in later stages of their careers. The average worker has a 30% chance of becoming disabled, so a short-term or long-term insurance plan provides backup. Millennials make up 35% of all pet owners, and a 2018 survey by the Society of Human Resource Management revealed that 11% of U.S. employers offered pet insurance, up from 6% in 2014, and one in three Fortune 500 companies offered it.

Companies can use surveys to find out what employees are seeking, and then shape ancillary benefit options accordingly. You can help employers achieve their strategic goal by providing what their employees want.

Why should companies offer ancillary benefits?

As an ancillary benefit, a dental insurance plan, for example, includes diagnostic and preventive services that go beyond maintaining employees’ oral health. Dentists not only evaluate periodontal disease but also diagnose symptoms of major health issues, such as diabetes, during routine exams. Early detection enables employees to seek treatment that may avoid more expensive interventions. It can help your company control long-term health care costs and provide financial stability for employees.

In a vision insurance plan, an annual eye exam can reveal symptoms of chronic conditions such as diabetes, high blood sugar or high cholesterol.

When you show the return on investment in an ancillary benefit to a company, through cost of premiums versus cost of claims, it can support the case for adding it for employees. You can offer a Delta Dental plan that easily complements, and integrates with, an existing group medical plan. This ancillary benefit can increase both workers’ job satisfaction and wellness.

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.

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