Facing the Challenges of Dental Benefit Plans

Viren R. Patel, DDS

When surveying our members and asking what concerns them most in their practices, the challenges related to dental benefit plan reimbursement is at the top of the list, followed by the increasing cost of dental school and staffing shortages. It’s clear that the range of concerns about dental plans varies as much as the types of dental plans that exist in the market, with fluctuating nuances and coverage shifts.

Just as the dental profession has witnessed advances in clinical techniques and shifting business models, the dental benefits marketplace also continues to evolve. The pressures in the dental benefits industry are comparable to those felt in thousands of industries and professions around the world — how to offer valued products and services while addressing the needs of their customers and containing costs. For dental benefit plans, employers are their primary customer. Employers are challenged with offering competitive benefit packages to retain and attract talent, as medical benefits take up a larger and larger part of the available health care benefit dollars. Dental coverage is a highly valued benefit by employees, falling right behind medical coverage and retirement benefits. In order to retain a dental benefit, many employers have shifted the cost of dental coverage to their employees, along with increased copays, something we’re witnessing firsthand in our practices.

The world of dental benefits is broad and encompasses many types of coverage. Commercial employer-based or individually acquired plans are common and well known, if not well understood, by the majority. The history and current offerings are presented by Dr. Charles Stewart with a discussion of the benefits and challenges of the differing types of commercial plans. Additionally, the author offers a perspective of what the future may bring in this area and how that may impact all those who participate in these types of plans.

Benefits provided by the government also exist for those who are unable to find care through other means. The reader will get insight into the unenviable task of the management of one of these programs from Jennifer Kent, the former director of the California Department of Health Care Services. The author discusses the barriers to change and the methodology as well as the avenues used to affect significant improvement in utilization of the Medi-Cal dental benefit.

The provision of health care to the elderly has been administered through the Medicare program. Historically, dental care has been excluded from that area and currently continues to be. However, in the past year or so policymakers on Capitol Hill attempted to address this by proposing a dental benefit in Medicare as part of the 2021 federal spending plan. It was ultimately removed from the bill that passed, but a need remains that has yet to be met. Dr. Elisa Chávez is well-versed in this topic and offers perspective on a dental benefit in Medicare, addressing points for and against the proposed benefit.

The pandemic and concomitant response had a vast number of unintended sequelae. One area that saw accelerated change was the provision of dental care through teledentistry. Benefit plan design will need to look to this area since it is quickly evolving. Those needs are discussed in this edition by an author with significant experience in this area, Dr. Nathan Suter. He brings to our attention the methods available for appropriate reporting and billing of these teledentistry visits as well as what we can expect in this arena as we move forward.

My personal journey with regard to dental benefits was influenced greatly by my time as chair of the CDA Dental Benefits and Economics Task Force in 2018-2019. I found that more information and a greater understanding of the differing perspectives allowed me to feel more at ease with the subject. Even though the thought of dental benefits often elicits an emotional response in some, it is my hope that after reading this issue of the CDA Journal, the reader will find this to be a more understandable and less frustrating subject. n