The Power of Prevention: Optimizing Dental Insurance for Preventative Care in the USA

October 10, 2024

Optimizing Preventative Care for Dental Insurance

Maintaining good oral health is critical for overall well-being, and access to comprehensive dental benefits is crucial in achieving this goal. From managing conditions such as diabetes and kidney disease to supporting overall preventive care, affordable dental insurance ensures that individuals can receive the necessary treatments and services. For employers, offering dental coverage promotes healthier employees and their families and lowers out-of-pocket costs and healthcare expenses. In this blog, we will explore the importance of optimizing preventative care for dental insurance, highlighting how it benefits employees and employers.

Why Employers Should Invest in Dental Benefits Despite Rising Costs

According to industry insiders, rising healthcare costs are now influencing dental benefits, which were previously considered low-cost and free from cost-cutting efforts. Some companies are reducing dental coverage due to medical plan inflation. However, employees place great value on comprehensive dental care. It is common for workers with dental benefits to view their health and quality of life more favorably, and there is a direct link between overall well-being and maintaining good oral health. While providing dental insurance may seem like an extra expense, it could lower medical costs and aid in recruiting top talent. Consequently, maintaining strong dental benefits can be a wise strategic investment in the well-being of staff members and the company's success.

Maximizing Your Dental Insurance Benefits: What You Need to Know

Dental insurance plans offer varying types of coverage, with one common model being the 100-80-50 structure. In this model, preventive care is typically covered at 100%, basic procedures at 80%, and major procedures at 50%. However, there is a growing trend towards the 100-80-80 model, which increases coverage for basic procedures to 80%. Basic procedures usually include dental extractions, fillings, and some types of periodontal work, often with a minimal deductible. Major procedures such as bridges, crowns, and dentures typically require a larger out-of-pocket contribution. It's important to assess if a plan covers orthodontic treatments, especially beneficial for those in need. Factors like network size and annual maximum coverage are crucial when evaluating dental insurance plans. While waiting periods are rare in group plans, understanding which procedures qualify as basic or major directly impacts the level of coverage provided. For further inquiries about dental insurance, feel free to contact the industry experts.

How Has Health Care Reform Affected Dental Coverage?

Dental care is considered essential health benefits for children up to 19 under the Affordable Care Act (ACA). Children's dental benefits have become a requirement of all non-grandfathered health plans since 2014 unless approved independent dental coverage is offered. However, this definition of critical health benefits does not include orthodontic treatments that are not medically necessary.

It's important to note that this requirement only applies to children, not adults. Unlike medical insurance, individuals are not mandated to have dental coverage to avoid penalties under the ACA. This distinction emphasizes the ACA's focus on ensuring comprehensive healthcare coverage specifically for children, while dental coverage for adults remains optional and separate from medical insurance requirements.

Thus, offering a stand-alone dental plan for your employees is extremely important, as it is not included in the essential health benefits under the Affordable Care Act.

Current Trends in Dental Insurance: What Employers Need to Know

Here, we will explore the current trends in dental insurance and highlight critical insights employers should consider when designing their benefits strategies.

The Link Between Oral Health and Overall Medical Well-being

The strong connection between oral and overall medical health leads to increased integration between medicine and dentistry. As a result, dental benefits are becoming more critical components of comprehensive benefit plans and wellness programs. Unfortunately, this can result in higher medical and dental costs for individuals and employers. For instance:

• Oral cancer has a higher mortality rate compared to cervical, testicular, thyroid, and laryngeal cancers.
• Diabetes is linked to a greater occurrence and progression of periodontitis.
• Periodontal disease is associated with coronary heart disease and stroke.
• Pregnant women with periodontal disease are at risk of delivering pre-term and low-birth-weight babies, which increases the child's chances of illness and death in infancy.
• Individuals with a history of periodontal disease may experience its recurrence without proper dental care.

Employees Seek Flexibility in Benefit

Dental coverage is a crucial employee benefit that can differentiate employers from one another. However, simply offering dental benefits isn't enough—providing a flexible and comprehensive dental benefits package is becoming a competitive advantage. Most importantly, employees want the freedom to choose a plan that fits their needs, whether opting for basic coverage at a lower cost or selecting more extensive coverage with higher premiums.

Comparing Dental Insurance Plan Designs: Which One Fits Your Needs?

This section will compare different dental insurance plan designs to help you choose the best one for your needs and budget. Understanding these differences is crucial for making an informed decision about dental coverage.

• Plan Structures: Dental plans typically fall into two categories: managed care (PPOs, DHMOs) and fee-for-service (Direct Reimbursement). Managed care plans control costs through network restrictions, while fee-for-service plans offer provider choice and reimbursement flexibility
• Annual Maximums:This refers to the maximum amount a dental plan will pay for covered services within a year. Employees need to understand this limit as it affects their out-of-pocket expenses for dental care.
• Coverage for Preventive and Routine Care: Most dental plans cover preventive care at 100%, which includes regular check-ups, cleanings, and X-rays. Routine care, typically covered at 80%, includes procedures like fillings and simple extractions. These services are essential for maintaining oral health and preventing more serious issues.
• Coverage for Major Procedures: Dental plans usually cover major procedures at 50%, including crowns, bridges, and root canals. The distinction between routine and major procedures is important, as it influences the level of coverage and out-of-pocket costs for employees.
• Custom Plans for Costco Members: Custom dental plans through Ameritas for small groups offer unique benefits not commonly found elsewhere. These plans include a broader range of services categorized as routine rather than major, reducing the financial burden on members. For example, services like root canals may be classified differently, significantly lowering out-of-pocket expenses.
• Coverage for Orthodontics: Included in the plan, orthodontic coverage helps offset costs for braces and other corrective treatments for children and adults. Dental plans vary widely in coverage, emphasizing the need to review specifics to understand included treatments and associated costs. For guidance, consult dental insurance experts.

Maximizing Value and Health with Affordable Dental Insurance

Choosing affordable dental insurance through The CBC Health Insurance Marketplace for Costco Members can significantly benefit your small business. By prioritizing employees' oral health with customizable plans and access to a broad network of skilled dentists, you ensure they receive essential dental care. This proactive approach helps employees maintain regular check-ups, promptly address dental issues, and promote overall wellness while managing costs effectively.

The CBC Health Insurance Marketplace for Costco Members simplifies healthcare decisions for small businesses by offering a straightforward approach to selecting and managing healthcare plans. This platform provides a curated selection of affordable plans from trusted carriers backed by personalized recommendations and seamless enrollment processes. Here’s how it can benefit your business:

Small businesses face unique challenges in providing comprehensive benefits like dental insurance. With The CBC Health Insurance Marketplace for Costco Members, you gain access to plans that fit your budget and meet the needs of your employees.

Explore The CBC Health Insurance Marketplace for Costco Members today to discover how our affordable dental insurance plans can support your small business's healthcare strategy.Contact us now to get started on improving your employees' oral health and overall job satisfaction.

Brought to you by the insurance professionals at Custom Benefit Consultants, Inc.

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