The next dental insurance industry in dire need of reform


Over the past decade, most debates and discussions about healthcare reforms have focused on Americans’ general health insurance plans and costs. And for good reason.

And although our healthcare system is convoluted and complicated, it becomes even more complex when we take a look at what’s going on with dental care.

The intersection of high insurance premiums, confusing government benefits, and a windfall on paperwork keeps many Americans from going to a dentist.

Even though 80% of Americans have access to dental benefits, nearly 35% of American adults did not see a dentist in 2019, according to the National Association of Dental Plans.

The reason so many people neglect to have their teeth checked is clear from the data: the cost of fitting.

And modern dental insurance, coupled with a myriad of various government programs, is a big reason.

Unlike most health care plans, dental plans have low limits on the number of benefits they will pay, between $ 1,000 and $ 1,500 per year. Premiums average $ 30 to $ 50 per month depending on the plan and the number of people covered.

Because patients use dental insurance to cover all aspects of their care, rather than emergencies, it adds to the price inflation of basic care, a phenomenon dubbed the “problem of social consequences” by economists.

This problem becomes even more complicated as almost all dental patients do not choose their plans on their own.

Currently, 93% of privately insured dental patients receive coverage from their employers, meaning there is little incentive to innovate direct-to-consumer options that would offer competition.

This incentive problem, coupled with a relatively opaque dental insurance market, means that costs will continue to rise unless we can agree on simple reforms to increase competition and transparency in the market. dental insurance market.

To do this, state legislatures and Congress should first seek to encourage patients to choose membership programs as dental plans, rather than traditional insurance. Using health savings accounts to purchase these memberships, as well as to pay for care, would be a huge improvement that would allow patients to contract for their own care.

It would be similar to the movement of direct primary care physicians, which offer direct monthly subscriptions to patients and do not accept insurance. Eliminating the insurance middleman means less bureaucracy, less paperwork and more time with patients. In addition, the prices are transparent and fair. That alone would provide better competition and prices for patients in need.

This would lead to a greater decoupling of health and dental insurance from employers, allowing patients and consumers to choose the plan that is best for them and their families.

On the transparency front, state legislatures should hold the dental insurance industry accountable with simple reforms that hold patients accountable when choosing their dentists.

Assignment of benefits laws, already passed in states like Colorado and Illinois, allow patients to choose whether they want insurance companies to pay dental clinics directly, saving patients the hassle of having to pay for dental clinics. pay up front and negotiate with insurance companies for reimbursement.

Likewise, network rental regulations, allowing dental clinics to overhaul and join insurance networks rather than being automatically forced into them, would keep prices low and transparent, if not predictable even before they start. enter the dentist’s chair.

As legislatures seek to reform healthcare, we must also keep in mind the growing dental bills Americans face every day, and hope lawmakers understand the need for more competition and transparency to better improve. dental care in our country.

Encouraging competition with traditional dental insurance, while promoting simple regulations to promote financial transparency, will serve to empower consumers and reduce the costs of care.

It would be bold and revolutionary for patients and would help encourage innovation in a sector where it has not always been most welcome.

Yael Ossowski is Deputy Director of the Consumer Choice Center.

– Internal sources


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