Broker blog from Delta Dental

Tag: cost savings

Effective discount: Understanding a plan’s true savings

When your group clients consider a PPO dental plan, certainly one of the deciding factors is savings — during a dental visit, how much will this plan save my employees?

Traditionally, a good way to judge this has been to consider the plan’s PPO network discount, or the discount offered on dental services when visiting a dentist within the plan’s PPO network. After factoring in the fees, the greater the discount, the better the plan, right?

Not exactly. While PPO network discount is one chapter of savings, it’s not the whole story. A more accurate way to gauge a plan’s true savings is to consider the plan’s effective discount. The effective discount considers the average savings enrollees receive when visiting any dentist, either in network or out of network.

It’s here where Delta Dental offers a unique advantage: the Delta Dental PPO™ plan with the Delta Dental Premier® network.

With most PPO plans, the PPO network is absolute — you’re in or you’re out. And if you visit an out-of-network dentist, you’re responsible for the full cost of dental services provided by that dentist. The Premier network offers a secondary network that acts as a “safety net” if a PPO enrollee can’t find, or chooses not to visit, a dentist within the PPO network.

While the Premier network provides a smaller discount than the PPO network, the combined size of the two networks — more than 155,000 unique dentists as of 2020 — ensures that most people covered under a PPO plan can visit a Delta Dental dentist and save. This large network enables Delta Dental to deliver a national network utilization rate of 94%, compared to an average PPO utilization of 65% for competitor networks.

And it’s this safety net that often makes a Delta Dental PPO plan a better value than one from another company.

For example, let’s look at a theoretical example in which there are two group PPO plans with identical fees: one from Delta Dental and one from a carrier without a secondary network. In each scenario, 10 people are insured. Five visit PPO dentists and receive a discount, and five visit non-PPO dentists. The Delta Dental plan provides a 35% discount at PPO dentists. The other plan provides a 36% discount at PPO dentists.

Given the otherwise identical scenarios, it might at first seem that the plan with the higher PPO network discount offers the better value. However, in the Delta Dental plan, four people can visit a Premier dentist for a 19% discount. Because only one person visits a non–Delta Dental dentist, the group receives a total effective discount of 25%. Contrast this with the other plan. Because half receive no discount at all, the effective discount is only 18%.

It’s not surprising then that Delta Dental offers groups the best effective discount in the country, averaging 29.4% nationally in 2019, according to a July 2020 study by Dental Actuarial Analytics. This equals more than $8.2B in savings for enrollees annually when compared to dentists’ average charges for services.

So, remember when speaking with your group clients: Savings is more than PPO discounts. When you consider effective discount, you offer a complete story. One with an ending your clients should like.

The cost correlation: Dental benefits may lower businesses’ overall health spend

4‑minute read

It’s common knowledge that oral health is linked to overall well-being. What might surprise you, however, is the significant impact employees’ oral health status can have on a business’s total health care budget. In fact, of the top 10 health conditions costing employers the most, five are linked to oral health.*

No. 1: Diabetes

Topping the list of costliest employer conditions is diabetes, affecting nearly one in 10 Americans. Not only do diabetics face a higher than normal risk for developing oral health problems like periodontal disease and oral infections, but these problems may be more severe for a diabetic person. It’s not all bad news though. It’s been suggested that treating gum disease can help control blood sugar in diabetic patients, which may slow disease progression. And, receiving routine dentist cleanings and practicing healthy oral hygiene habits may help to lower HbA1c levels (average blood glucose over time).

No. 2: Cancer

Oral cancer is likely not the first cancer that comes to mind for most of us. Yet, head and neck cancers (85% of which are oral) account for approximately $3.2 billion in treatment costs each year.

Oftentimes, the early symptoms of oral cancers go unnoticed by patients, making them particularly dangerous. That’s why regular dental exams are so important. Dentists and dental hygienists may be able to identify the signs and symptoms of oral cancers when they’re still in the early or even pre-cancerous stages.

No. 5: Heart disease

The dental industry has been aware of the correlation between heart disease and oral health for years, and supporting evidence continues to emerge. While we still can’t say the relationship between oral health and heart health is causal, new research suggests that poor dental health, including gum disease and infrequent toothbrushing, may be a risk factor for heart disease.

No. 6: Hypertension

Recently, an association between hypertension and dental health has also been found — specifically blood pressure control. A new study showed that those with gum disease were less likely to respond to hypertension medications than those with good oral health. The authors of this study go on to say that “those with high blood pressure might benefit from regular dental care”.

No. 10: High-risk pregnancy

Compared to the average employer medical costs for a healthy, full-term baby, the costs for premature and/or low-birth weight babies is nearly 12 times as much. While the relationship between periodontal disease and adverse pregnancy outcomes is still being explored, we do know that a mother’s health can impact her baby — and oral health is no exception. Research suggests that expectant mothers with poor oral health may face higher risks of pre-term delivery and of passing disease-causing bacteria to their child. This makes it even more important for expectant mothers to receive regular dental exams during pregnancy. The dentist can evaluate the individual needs of the mother and may even recommend an additional cleaning.

How can dental benefits help?

Regular dental care can help manage certain health conditions and even detect some early, which can help prevent costly medical expenses in the future.

However, dental benefits may be able to do more than cover routine dental care to improve wellness. Ask these questions to find out how well a dental carrier can boost overall health and your clients’ bottom line:

  • Is there extra support for those with chronic conditions such as diabetes or heart disease? Providing additional coverage to enrollees with certain medical conditions may prevent or halt the progression of disease, which can help manage dental and medical expenses down the road.
  • How can clients track employees’ oral health status? Regular reporting on enrollees’ oral health habits can highlight where a group is doing well and help identify areas where enrollees can improve oral health, and in turn, improve overall health.
  • How is oral health supported during pregnancy? Are additional cleanings covered? An extra cleaning during pregnancy can lead to healthier babies and may lower certain pregnancy risks associated with oral bacteria.
  • Are oral health and wellness resources readily available? Enrollees may not even be aware of the impact oral health can have on their overall health. Carriers who provide valuable wellness resources can help encourage enrollees to be active participants in their oral health.

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.


*The oral health information in this article is not intended to be used as medical advice. Always consult a licensed dentist or other qualified health care professional for any questions concerning oral health.

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.

© 2021 Insider Update

Theme by Anders NorenUp ↑