network data is useful. netminder knowledge is powerful.

The NetMinder Blog

How the Affordable Care Act (ACA) is Influencing Adult Dental Insurance Coverage

Posted by Laura McMullen on Thu, May 15, 2014

Adult dental insurance is a hot topic thanks to the Affordable Care Act (ACA) and Healthcare.gov. Under the new healthcare law, dental coverage for children 18 and younger is considered an essential health benefit that must be included in all plans sold on exchanges. For adults, it’s a different story: insurers don’t have to offer adult dental coverage, nor do adults have to purchase it.

dentistsThis situation could lead to fewer healthy adults purchasing dental coverage because their health insurance budget is committed to the mandated ACA coverage. This effect may drive up dental premiums for everyone if the pool of prospective purchasers consists only of those needing more extensive and costly dental treatments. From a network perspective, dentists may find themselves joining more networks to fill in the gaps and gain new patients.

Nancy Smith lays out the ramifications of ACA on adult dental coverage and concerns from dentists in this Sunshine State News article “Obamacare Leaves Gaping Cavity in Adults’ Dental Health”.

Individual Adult Dental Insurance Plans

Consumers may start looking for individual adult dental insurance plans. This is an opportunity to promote a variety of dental plans, ranging from discount plans to stand-alone insurance plans to dental benefits that are embedded in qualified health plans on exchanges. These plans can differ significantly from traditional, employer-sponsored dental plans and may require education to ensure member satisfaction.

dentist toolsFor example, “annual maximum” is an important term when talking about adult dental insurance. The annual maximum, or benefit cap, limits the maximum amount the insurer has to pay, making the consumer responsible for any additional costs beyond the maximum. Due to ACA, new health insurance policies do not include a benefit cap. However, for consumers looking for both health and dental insurance, benefit caps can still exist in adult dental plans under the name “annual maximum.”

Read more on this topic in the article “What is the Problem with Adult Dental Insurance Plans on Healthcare.gov?” by Naomi Mannino on www.mainstreet.com. Of course, consumers should check that their providers are in the network.

Voluntary Group Plans

In some cases, another option is voluntary group dental insurance. Caitlin Bronson, in Insurance Business America, reports that some groups are dropping health insurance plans so that their employees can use the exchanges but adding voluntary ancillary benefits, like dental and vision plans. She writes, “Roughly 80% of voluntary sales are dental coverage, with a projected 2% increase in 2014, Towers Watson found in its 2013 Voluntary Benefits Survey.”

These plans allow employers to offer a popular benefit and pass the cost along to their employees via payroll deduction, which in some cases eases the sting of changes in health insurance benefits. Some believe that voluntary plans don’t offer enough coverage for the cost to satisfy commercial clients and their employees.

With several options to choose from, will healthy adults opt for dental coverage?  

Tags: compare networks, dental network, network providers, health insurance, Affordable Care Act, dental providers, dental insurance, healthcare benefits, ACA, dental benefits, dental insurer

Narrow Networks Add Complexity to the Health Insurance Business

Posted by Laura McMullen on Thu, Apr 24, 2014

narrow networksThere’s been a lot of buzz in the media lately about narrow networks in health insurance plans on the federal and state health insurance exchanges. This has prompted a larger discussion about network adequacy and the trade-offs between cost control and choice. Carriers Defend Use of Narrow Networks as Fair, Market-Driven Options for Consumers, an article from Health Plan Week reprinted in AIS Health Reform Week on April 4, 2014, sums the situation up well, discussing network adequacy, consumerism, and transparency.

Here are some questions to think about when you are comparing provider networks, whether you are managing a network, selling insurance plans to employers, or purchasing a plan for your company or family.

1. Are the right types of providers in the network? When provider networks get narrower, the definition of network adequacy shifts from the size of the network to the types of providers that participate. Employers and other group benefit sponsors are asking questions like: Are there enough PCPs or optometrists? What about cardiologists or oral surgeons? How many radiologists or ER doctors are near my members? (Download our whitepaper All Provider Networks Are Not Created Equal for more.)

2. Is the carrier financially and administratively reliable? Narrow networks reduced one of the barriers to entering the health insurance market, namely the need to have a large provider network. Many new entrants to the market raise questions about financial solvency and claim payment speed. 

    • In the dental insurance industry, we’ve seen established brands like Prudential come back to the market with a leased network and outsourced back office only to exit after a few years. (See our blog post Prudential Exits Dental Benefits Market; Others to Follow? for more.) 
    • In the health insurance industry, more than 50% of hospitals and health systems responding to a June 2013 Advisory Board Co. survey said that they planned to launch a health insurance plan by 2018 or they already had one. (See our blog post More Health Systems Becoming Payers for more.)

3. Are the right providers in the network? From the consumer perspective, all networks are narrow – they only include the providers they use! Many people are accustomed to the large PPO networks that have been popular in employer-sponsored plans over the last several years, so they may be surprised by narrow networks that don’t include popular providers and academic medical centers. Communicating early and often, like B2C companies do, could make a big difference here. For more about how consumers look for health care information online, see our blog post Consumers Seek Real Data Online for Health Decisions.

Key questions for the Department of Health and Human Services in the coming weeks and months will be which types of providers are essential and how large is an adequate network. As they work on the answers for plans on the exchanges, carriers will be watching closely to see what the impacts are for plans off the exchanges.

How will you assess your network and your competitors’ networks?

Tags: compare networks, market comparison, network providers, health insurance, narrow networks, Affordable Care Act, healthcare reform, health reform, healthcare exchanges

When Is a City Not a City?

Posted by Laura McMullen on Wed, Mar 26, 2014

One of the most common questions we get from NetMinder users when they run reports comparing provider networks in specific cities is why aren’t there any providers in ______________? (Fill in city name here.)

Often the reason is that the client’s definition of a city is different than the preferred US Postal Service definition. That’s why, to ensure you always get apples-to-apples comparisons, we base the city designations in NetMinder on the USPS preferred city designation. 

  • Cleveland is a good example. There are a number of ZIP codes in Cleveland that have both preferred and acceptable city names. See list below:

Cleveland zips resized 600

  • Here’s a screen capture from www.usps.com for zip code 44118 for an example of preferred and acceptable city names.

Cleveland preferred

So, what can you do when you’re running a NetMinder report to avoid this problem? The best thing to do is to run your report at the ZIP code or MSA level. Those geographic areas are more firmly agreed upon than city names. MSA, or Metropolitan Statistical Area, reports can be helpful in this situation because city names are included in the name of the MSA, i.e. CLEVELAND-ELYRIA, OH. If you choose to run a county report, I recommend including city and 5-digit ZIP subtotals to make sure that you include all of the areas you need since county names might not be as familiar as city names.

Try this tip out when you log into NetMinder next time and let us know how it goes in the NetMinder User Group on LinkedIn.

 

Tags: compare networks, data management, business intelligence, data analysis, provider counts, ZIP codes and cities

 

CONNECT WITH US

 

NetMinder delivers industry leading network comparison tools that make your sales force more effective and your recruiters more efficient. Network data is useful. NetMinder knowledge is powerful. Learn More About What We Do

 

RESOURCES