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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 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” by Naomi Mannino on 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

Which Provider Counting Method Do You Prefer?

Posted by Aaron Groffman on Mon, Dec 09, 2013

I asked attendees at my recent NADP CONVERGE 2013 break-out session which counting method they prefer to use for comparing provider networks, and the majority answered “unique providers.”

Counting Methods in NetMinder Dental PPO Reports

Based on NetMinder user data (as illustrated in the chart), access points (each provider at each of their locations) is still used about half the time, but the unique providers counting method is catching up.  In 2012, 36.7% of NetMinder dental PPO reports used unique providers as the counting method, and 53.7% used access points. This year we started to see a shift, with 40.9% of reports using unique providers and 50.7% using access points.

It makes sense that unique providers would be the preferred counting method for NADP attendees, who tend to be senior level managers looking for a big picture view of how their company is performing. Using unique providers simplifies the equation because it means each provider is counted once regardless of how many locations he or she is listed at. This eliminates duplication caused by a) associates who change offices and b) providers who are listed at multiple locations to facilitate claim payment.  Looking at access points with an overlay of our exclusive practicing locations indicator offers a similar view to counting unique providers with the added benefit of including multiple locations that have been validated by claim activity.

Which counting method do you prefer and why?

Tags: network growth, dental network, network providers, dental providers

NetMinder Data Reveals Dental PPO Network Trends

Posted by Aaron Groffman on Thu, Oct 03, 2013


Size is one of the key ways to measure network strength, and the latest NetMinder data reveals that dental network size continues to increase.

There are two ways that networks generally grow:

  • Organic growth through direct contracts with the dentists themselves
  • Partnerships, leases and reciprocal arrangements

We see a clear trend that indicates both are happening. More networks are partnering, and dentists are joining more and more networks.

Dental Network Trends NetMinder Aug2013 resized 600Out of the top 15 national dental PPOS, 13 have one or more partners, according to our data. More than half have three or more lease partners, and the partners are not limited to traditional rental networks. Even carriers are offering some or all of their contracted providers in partnership arrangements.

Additionally, dentists continue to join more networks. From March 2009 to March 2013, the average number of networks per dentist in the top 15 networks grew from 6.2 to 7.4. Now 37% of dentists are in 11-15 networks, compared to just 26% of dentists participating with that many networks in 2009. By contrast, the
number of dentists in one to five networks shrunk from 55% to 46%.

Part of this increase can be attributed to the multiplier effect. When a dentist joins a lease network, he or she ends up in many networks.

I’m going to be diving even deeper into the data in the coming weeks, so stay tuned for more dental PPO network trends!

Tags: network growth, dental providers, dental PPO networks, dentists

What Is the Best Job of 2013? Dentist!

Posted by Aaron Groffman on Tue, Mar 19, 2013

Dentists have something to smile about. They have the best job in the country, according to a U.S. News & World Report study. The study ranked the top 100 jobs of 2013 based on the number of openings, the chance to advance and be professionally fulfilled, and the ability to meet financial obligations.

With an overall score of 8.4 out of 10 and an unemployment rate of just .7%, the dental profession outranked other top 10 jobs, including registered nurse, pharmacist and web developer.

Dentistry is a growing field with predicted employment growth of about 21% between 2010 and 2020, according to the U.S. Bureau of Labor Statistics. More than 27,000 job openings for dentists are expected during that time. And with a median salary of $142,740 (in 2011), it is one of the highest paying healthcare professions.

This is all great news for insurers and consumers who will benefit from more choices of dental providers and – as many will open private offices – more access points.

As of November 2012, there were more than 195,000 professionally active dentists in the U.S., as reported on, a Kaiser Family Foundation project. A NetMinder data analysis of dental PPO trends shows that these providers are joining more insurance networks, and their number of reported practice locations is growing.

In March 2012, the average national dental PPO network contracted with more than 72,000 unique dentists, up 8.7% from the prior year. If the number of dentists in the U.S. continues to grow, they won’t be the only ones smiling; consumers and insurance companies will be glad to see more providers and more practice locations in their insurance networks.

Tags: dental network, dental providers, dental insurance





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