Consumers with a dental benefit are more than twice as likely to visit their dentist. However, consumers are being asked to share a larger portion of their premiums. This cost pressure from employers is transferred to dental plans as they maintain low premiums and lower reimbursement rates to dentists. According to the National Association of Dental Plans (NADP), in 2015 the average dental care PPO premium for a single employee was down 1.5 percent from 2014. This explains why you spend more time today with administrative issues such as claim denials and disallow policies.
Consumerism is on the rise. Because consumers bear an increasing percentage of their total costs, consumerism is on the rise as patients seek more transparency related to cost information. You may notice that more consumers are price shopping for their dental care because of these pressures.
PPO plans define the dental benefit market. While the average dentist participates in about six dental benefit plans, the characteristics of those plans is changing. For instance, the market share of preferred provider organization (PPO) plans is on the rise and constitutes more than 80 percent of the current market according to NADP. And, there is an increased focus on directing plan beneficiaries to in-network dentists.
Dental benefit plan design has largely remained unchanged for many decades. Dentistry has always been among the most valuable and affordable health care services, and recent trends support that. However dental plan design has largely remained unchanged. A few positive trends include plans offering “roll-over” of annual maximums and “preventive and diagnostic credit” (for example, some preventive and diagnostic services do not count towards the patient’s annual maximum).