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Education on Dental Plans

Webinar Recordings

July 26, 2016: Signing the Contract: Understanding PPOs

June 21, 2016: Advocacy and Third Party Issues

Today's Plans

According to data from the National Association of Dental Plans:

In 2014

  • 204.6 million people (64% of the US population) had a dental benefit—up from 170.5 million (57%) in 2006.
  • PPOs accounted for 82% of the dental plans in the market—up from 62% in 2006.
  • The commercial market had 77.9 million people (52%) with fully insured dental benefits versus 71.1 million (48%) with self-funded plans. 
  • 47% of PPO plan maximums (in-network) were $1500 or more per year, compared to 55% in 2011.
  • The percentage of PPO enrollees (in-network) reaching, or exceeding, plan maximums was 2.8%, while 1% (out-of-network) reached the same annual maximum.
  • Use of in-network services from PPO networks is clearly trending up with 79.6% of procedures performed in-network for PPO plans.
  • 23.5% of group dental policies are fully employee paid (i.e. voluntary) up 1.5% from last year. 6.5% of group dental coverage is completely paid for by the employer, up from 5.4% a year ago.

In 2015

  • The average PPO premium per enrollee per month was $31.9, down 1.5% from 2014.  DMHO premiums increased 2.3%, and indemnity premiums 8.5%, from a year ago.

Additional research from the ADA’s Health Policy Institute sheds more light into issues related to the dental benefits industry.

Learn More About Dental Benefit Plans

Most dental offices need to interact with dental plans on behalf of patients seeking care at their practice. It is important that every dental office is educated on how dental plans work. Read more about Dental Benefits. Don’t forget to watch short tutorials on select topics at the Dental Benefits Video Series.  Tutorial topics include:

  • Part 1: Signing the Contract: Understanding PPOs
  • Part 2: Common Processing Policies
  • Part 3: Coding on a Claim Form
  • Part 4: Avoiding Claim Errors & Addressing Denials
  • Part 5: Discount Dental Plans and In-office Dental Plans
  • Part 6: Complying with Commercial Dental Plans Audits/Reviews
  • Part 7: Bitewings and Extraoral Image Procedure Codes
  • Part 8: Coordinating Benefits: How Much of My Fee Should I Write-Off?
  • Part 9: Making Sense of EOB Language

Don’t see a topic you are looking for? Let us know at dentalbenefits@ada.org