Dental problems can have a significant impact on one’s overall health. This is why Californians must have access to affordable dental care.
Safety-net providers have successfully lobbied to restore some optional adult dental benefits under Medi-Cal, the State’s low-income healthcare program. But, the program still needs long-term funding solutions.
Transparency
Dental insurance has long been a bit of an overlooked stepchild in the health care system, despite mounds of evidence that link a healthy mouth to everything from better pregnancy outcomes to a healthier heart. It is reflected in the fact that only 85% of Californians have dental coverage, most through employer-sponsored plans.
Those with coverage often find themselves disappointed in the limited value offered by their plans. Many dental insurance plans offer low maximums and hefty coinsurance rates, meaning patients often spend much more out of pocket than expected.
Some also point to the fact that dental insurance isn’t regulated like health insurance, which means companies can limit their policies without regard for patient impact. That could be seen in the 2022 election when voters in California passed a ballot initiative requiring dental insurers to spend at least 83% of their premiums on actual patient services.
Dental benefits are essential to people’s overall health, but consumers must consider their options before purchasing any dental plan. An excellent place to start is by examining the monthly payments, annual maximums, and waiting periods for each available option. This can help consumers avoid getting stung by hidden costs and maximize their coverage.
Moreover, individual dental insurance in California provides personalized coverage for residents, ensuring access to essential oral healthcare services tailored to individual needs.
Resolving Conflicts
The parties involved in conflict need to understand each other’s perspectives. Often, this can be accomplished through facilitated, open dialogue and brainstorming in a neutral setting. However, sometimes, it may be necessary to take a more active role in the resolution process to ensure that both parties feel satisfied with their agreement.
Dental coverage is lightly regulated, unlike health insurance, and many in the industry would like to keep it that way. For example, The Democrats’ plan to expand dental coverage was opposed by the ADA as part of Medicare in 2021 because they believed it could increase their administrative load or offer a reduced rate of reimbursement that they wouldn’t want to accept.
If the political will ever be there to restructure dental insurance to look more like health care, some of the same types of regulations that apply to medical plans would likely be used for dental coverage. This could mean higher minimum MLRs or more oversight of the financial aspects of the industry. This is something both dentists and insurers may be able to live with if it doesn’t mean significantly changing the current structure of the product.
Compliance
Dental coverage has always been an oddball in the broader healthcare world. It’s not as heavily regulated as medical insurance and tends to get siloed into its corner. Despite mounds of research linking oral health to other physical issues, including heart disease, depression, and pregnancy outcomes, many patients find it hard to afford the visits they need. Even those with dental insurance need help to use it, with several studies showing that access to it does not necessarily translate into actual utilization.
But that doesn’t mean there aren’t ways to change the status quo. One example is a move to put dental in the same regulatory boat as medical, requiring insurers to spend a certain percentage of their premiums on medical claims and improving care quality rather than administrative fees. That would be a win for dentists keen on more money. But dental insurers and the National Association of Dental Plans aren’t as fond of the picture, arguing that low-premium products like dental can’t be held to the same standards as higher-premium ones.
Whether it’s negotiating contracts, working with plan provider appeals, or reviewing dental plan rules and regulations, CDA has a broad range of resources and trusted expertise designed to support dentists in navigating the complexity of the current landscape. Check out our robust library of resources or learn more about navigating the complex nuances of working with dental benefits at CDA Presents.
Accountability
Dental insurance is different from other kinds of coverage. Compared to health or homeowners insurance, dental plans typically don’t have potential upsides as high as those other policies, and they often have limits preventing people from getting care when needed. Instead, dental insurers usually cover a percentage of costs—100 percent for preventative services like cleanings and checkups, 80% for minor work (like fillings), and 50 percent for major work (like crowns or implants).
While that doesn’t mean dental insurance isn’t valuable, it does mean patients should be careful about how much they spend on it. Some dental problems are unavoidable, but many can be prevented or delayed by following basic hygiene (brushing and flossing) and visiting a dentist every six months for professional cleanings and X-rays.
As the word accountability has become a central part of discussions in the fields of ethics and governance, it has also been incorporated into other languages with names like responsabilité (French), responsabilidad (Spanish), and Verantwortlichkeit (German). But, it is only recently that we have begun to see the concept of accountable care emerge as a meaningful part of health policy in the United States. It’s an exciting development that will help us address the most complex challenges of achieving sustainable, high-quality care.
