For payers, ensuring comprehensive healthcare coverage for beneficiaries is critical for gaining new members, retaining current members, and ensuring a high-quality member experience. Dissatisfaction with dental coverage and care is often a driver of shopping, but not always switching as consumers are often hard pressed to find a better alternative.
Dental health is an integral aspect of overall well-being, and it’s essential to understand consumer preferences for dental benefit options. In this article, we’ll explore the choices available for dental coverage and discuss preferences, premium differences, and benefit variations available to consumers.
Physical Health Implications from Poor Dental Health
Dental care can play a significant role in an individual’s overall health and quality of life, making choosing the right dental plan of utmost importance. Here are several ways in which oral health can impact their well-being:
CareQuest Institute for Oral Health. Impacts Beyond the Mouth. Boston, MA; June 2020. DOI: 10.35565/CQI.2020.4002
Prioritizing dental health directly influences overall health outcomes. By promoting preventive dental care, insurers can reduce the likelihood of expensive medical claims related to systemic diseases, like those listed above that can be associated with poor oral health. Moreover, investing in dental coverage encourages policyholders to seek regular dental check-ups, preventing costly treatments and emergency interventions. A focus on oral health aligns with the broader goal of proactively managing healthcare costs and promoting long-term well-being, ultimately leading to more sustainable and cost-effective insurance programs.
Coverage Options and Preference
It’s important to consider the preferences and needs of beneficiaries when making decisions about dental coverage. What things are going to impact the decision-making process when determining which plan type is right for them?
Stand-Alone Dental Plans: Separate insurance policies offered by private insurance companies. These plans allow beneficiaries to add dental coverage to their existing Original Medicare/MedSupp or Medicare Advantage plans. There are a variety of options to choose from and payers can help beneficiaries select plans that align with their specific needs. Seniors with specific dental needs or those requiring extensive dental care may opt for stand-alone dental plans. Payers can help beneficiaries evaluate the range of stand-alone plans available and choose the one that best suits their needs.
Embedded Dental Benefits: Included within most Medicare Advantage plans (Part C). These plans bundle dental coverage with medical and prescription drug benefits. Ensuring that the embedded dental benefit meets the needs of beneficiaries is essential for both member acquisition and retention. Some seniors prefer Medicare Advantage plans with embedded dental benefits as they offer the convenience of a single plan that covers medical, dental, and prescription needs. MA embedded dental plans can also put dental benefits on a flex card, which some seniors enjoy.
Dental Club: A dental club typically refers to a membership or subscription-based service related to dental care. These clubs are designed to provide individuals with access to discounted dental services, preventive care, or other oral health-related benefits. Dental clubs operate independently or in collaboration with dental practices, offering members various perks such as reduced rates on dental treatments, regular check-ups, cleanings, and sometimes additional services like teeth whitening. Dental clubs can offer simplicity and transparency for those who find managing insurance to be confusing. While the premium is often similar to that of a traditional dental plan, the membership plans don’t have annual deductibles, waiting periods, or maximum benefit limits, allowing members to use the provided discounts for unlimited treatment.
In addition, an estimated 68.5 million adults do not have dental insurance according to the 2023 State of Oral Health Equity in America survey from CareQuest Institute. Of the 68.5 million, those aged 60+ are most likely to be uninsured.
Premium and Benefit Differences
Stand-alone dental plans come with separate premiums that can vary widely based on the level of coverage and the insurance provider. According to Healthcare.gov, in 2024 there is a wide array of plans and premiums available. Comparing these premiums and assessing how they fit into the beneficiaries’ overall budget is essential. Surprisingly, the average premium amounts decreased from the 2023 rates.
Insurance carriers play a vital role in helping beneficiaries make informed decisions about their dental coverage. By understanding the choices available, considering seniors’ preferences, and keeping an eye on potential changes on the horizon, payers can ensure that beneficiaries have access to comprehensive and suitable dental care as part of their Medicare coverage.
Want more insights on this topic? Our 2024 National Dental Benefit Design Conjoint Study is for you!
With dental access, design, and cost-share structure remaining as dominant factors in overall selection criteria, this national conjoint study will help product developers design a dental benefit that drives the most value — whether embedded in MAPD plans or as a stand‑alone dental offering.
Key items we will cover include:
https://www.carequest.org/resource-library/uninsured-and-need
https://www.carequest.org/topics/medical-dental-integration
https://www.healthcare.gov/dental-plan-information-2023/
https://www.healthcare.gov/dental-plan-information-2024/
https://www.nidcr.nih.gov/research/oralhealthinamerica/section-1-summary