Broker blog from Delta Dental

Tag: COVID-19 (Page 1 of 2)

Client considerations for COVID-19 vaccines

The speed and efficacy with which COVID-19 vaccines have been developed is a testament to human ingenuity and the drive to create a safer world for us all. The three vaccines that are widely available in the U.S. (Moderna, Pfizer and Johnson & Johnson) have all received emergency authorization by the FDA after demonstrating both efficacy and safety, but there are other issues your clients may want to consider when deciding on how to approach a vaccine policy.

What options do employers have?

There are three main courses of action your clients could take when it comes to employees and vaccines:

  • Do nothing. This means choosing not to implement a company-wide vaccine policy and not advocating for and encouraging vaccinations. Doing nothing may not be the optimal choice from a public health perspective, but it’s certainly a valid one from a legal standpoint. Mandating or incentivizing vaccination could help to reduce increased costs or absenteeism from employees, but it can also lead to exposure to legal liability depending on how such policies are implemented (and how litigious employees are).
  • Encourage and incentivize vaccination. This is a gentler approach than outright mandating vaccinations as a condition of continued employment. Encouraging employees to get vaccinated is legally safe, although it may run the risk of upsetting employees who don’t believe in vaccination, who have concerns about vaccine safety, who have health considerations that keep them from getting vaccinated or who simply don’t like feeling pressured when it comes to managing their health. Incentives, such as offering paid time off or a bonus to employees who get vaccinated, must be carefully implemented, however. Aside from the cost considerations that comes with bonuses and incentives, employers may find themselves legally liable for any issues that arise from implementing on-site vaccinations.
  • Mandate vaccination. This is an aggressive option, but it’s certainly the most effective from the point of prioritizing the health and safety of employees. Mandating that employees get vaccinated is generally legal (although it may not be in some states), but it’s possible that some implementations could put your clients at legal risk (for example, setting up on-site vaccinations or inquiring about employees’ personal health to determine their eligibility for vaccination).

Which employees should get vaccinated first?

Until vaccines become more widely available, it’s best to prioritize employees who are most vulnerable to exposure and at greatest risk of complications from COVID-19. Of course, in health care and senior care industries, everyone with regular contact with the ill and elderly should be vaccinated. Outside of these industries, your clients should consider prioritizing:

  • Employees who work in close physical contact
  • Employees who have regular exposure to customers and other members of the public
  • Employees who have regular exposure to heavily trafficked enclosed spaces, food products or other settings where infection may be a risk
  • Employees who are 65 or older
  • Employees who are 16–65 with underlying medical conditions that increase the risk of life-threatening COVID-19 complications

What are the risks of implementing a vaccine policy?

Your clients could get into legal trouble if pre-screening vaccination questions aren’t job-related and consistent with the requirements of their businesses. To avoid this outcome, they should make sure that any pre-screening questions are related to the job and that they can prove that unvaccinated employees pose a direct threat to the health and safety of other employees. Similarly, your clients could get into legal trouble if they attempt to prevent workers’ concerted activity, such as expressing opposition to mandatory vaccines.

Employers should make sure to follow state and local laws, as well. Some locales may have prohibitions against mandating vaccines that more strict than state or federal law.

Setting a policy and moving forward

Before settling on the policy that’s best for their company and their employees, there are a few final things your clients should consider.

  • Make sure to follow all federal, state and local laws. Your clients won’t want to put their organization at risk of legal exposure. It’s best to do some research and stay up-to-date on the latest laws and regulations.
  • Get a sense of how their employees feel. If your clients have employees who feel very strongly about vaccines, either adopting a mandatory policy or doing nothing may cause disquiet. Taking surveys of employee sentiments can be a good way to decide how to craft a message.
  • Identify who should be doing the communication. Figures like respected managers, team leaders and union officials can be excellent ambassadors for company policies, especially in larger organizations where employees may not have personal relationships with upper management.
  • Be transparent. As always, communication is key when it comes to rolling out new policies that can affect employees’ work lives. Your clients should let employees know both what their COVID-19 vaccine policy is and how that position was reached. They should be sure to listen to and address employee concerns, even if the company’s policy remains firm.

Regardless of what policy your clients decide to implement, wearing masks and respecting social distancing will stay important aspects of infection management. Even as vaccines become more readily available, maintaining practices and procedures to minimize the chance of infection and help their entire organization stay healthy is essential.

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.

Common questions clients may have about the COVID-19 vaccine

As the COVID-19 vaccine is becoming more accessible throughout the country, you may find more of your clients and their employees talking about it and asking questions. Unfortunately, there’s a lot of conflicting and inaccurate information being spread through various media channels. Staying on top of the truth can be a full-time job, but here’s a list of common questions and some points you can bring up in case you hear concerns about the vaccine.

Is the vaccine safe?

Yes. Multiple expert sources, such as the Mayo Clinic and the Centers for Disease Control and Prevention (CDC), have attested to the vaccines’ safety. There are multiple reasons given why someone might be concerned about the vaccine’s safety, but the most common include:

  • Concerns about catching COVID-19 from a vaccine shot. There is no live virus used in the vaccines, so people who receive them can’t contract COVID-19.
  • Concerns about the vaccine damaging cells’ DNA. mRNA vaccines don’t alter cell DNA. Instead, they teach cells how to make a protein, which generates a response that will help the immune system target identical proteins in the COVID-19 coronavirus.
  • Concerns about the vaccines being developed recklessly or too quickly. The vaccines have been tested on tens of thousands of patients. Pfizer and Moderna have published ingredient lists for their vaccines, and the mRNA technology used to make the vaccines has been in development for over 30 years.

I’ve heard reports of people having aches, chills and other symptoms after getting vaccinated. Is this an issue?

No. Some people who have gotten the vaccine have reported muscle pain, chills and headaches, but that is not unusual for vaccines. These are part of the body’s normal immune response. But those who have had allergic reactions to vaccines in the past (which are due to the ingredients used in the vaccines), should first consult with their health care providers.

Should I still get a vaccine if I’ve had COVID-19 previously?

Yes. It’s not clear if having contracted COVID-19 previously grants long-term resistance and immunity, like having contracted chicken pox does. Even for those who have been infected previously, the CDC still recommends getting vaccinated.

COVID-19 doesn’t seem that deadly. Should I get a vaccine if I’m not in a high-risk category?

Yes. It’s true that as a percentage, most people who contract COVID-19 don’t die from it. Still, there can be serious long-term consequences such as lung, heart or brain damage. And even someone who doesn’t get seriously ill can still spread the disease among others who are more vulnerable. Getting a vaccine helps us protect not just our families and loved ones, but also society as a whole.

Once I’ve been vaccinated, do I still need to wear a mask or socially distance?

Yes. Even if a person has been vaccinated, that doesn’t mean that he or she can’t still spread the virus. It takes at least 10 days for the body to develop antibodies to the virus, and the number of antibodies present only goes up with more time. Additionally, research hasn’t conclusively determined if the vaccines prevent asymptomatic infection and spread (although it is likely that they do). Wearing a mask and socially distancing are also good behaviors to model for those who haven’t been vaccinated yet. By getting vaccinated and following other preventive measures, we can all do our part to end the pandemic sooner!

I’ve heard that the vaccine contains a chip inside that lets the government and corporations track people who get vaccinated. Is this true?

No. Some syringe makers include a microchip within the labels of their products so that health care providers can track the shipping history and origin of doses of vaccine. There is no chip within the vaccine itself.

I heard that the vaccine targets a protein that occurs naturally in pregnant women and can cause fertility issues. Is this true?

No. An amino acid sequence is shared between COVID-19 and a placental protein found in pregnant women, but the sequence is too short to trigger an immune response by itself. COVID-19 vaccines won’t cause fertility issues in women.

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.

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