Nevada dentist David White saw diseased, rotten teeth in the mouths of patients who routinely postponed exams and avoided minor procedures such as fillings. While dental phobia is a factor, White said, the main reason people avoid treatment is cost.
To help patients who don’t have dental insurance, White began in 2019 to offer a membership plan that looks a lot like an insurance policy, except it’s only valid at its Reno office. and Elko. Adults pay $ 29 per month – or $ 348 per year – and receive two free exams, two cleanings, x-rays and an emergency exam, services worth $ 492. They also get a 20% discount on office procedures such as fillings and extractions.
About 250 of White’s patients have signed up, and that has led to many going more frequently for routine checkups and getting needed treatments, he said. “It pushes patients toward better oral health,” White said.
It is among the quarter of dentists nationwide offering memberships, according to a 2021 survey of 70,000 dentists by the American Dental Association.
These in-office plans are largely aimed at the 65 million Americans who do not have dental insurance and have to pay for all of their care out of pocket. Dentists also prefer plans over management of insurance plans, as they do not have to deal with sharply reduced reimbursement rates from insurers, wait for prior approvals to provide services, and delay payment of their services. complaints.
Patients know in advance what their personal expenses are, and they don’t have to wait and see what their insurance will cover.
Lack of dental coverage contributes to the postponement or abandonment of dental care by 1 in 4 adults, according to a KFF analysis of a 2019 national survey.
Kleer, a Wayne, Pa., Company established in 2018, has helped more than 5,000 dentists implement the offerings.
“Enrollment patients act like insured patients and enter as much as insured patients, but they pay less for coverage while dentists get paid more,” said CEO Dave Monahan. “All we do is cut out the middlemen,” he said.
Monahan said business has skyrocketed during the Covid-19 pandemic as more dentists, facing higher costs for personal protective equipment and more patients without professional coverage, have seen the need for such plans.
Anthony Wright, executive director of consumer health advocacy group Access California, said he was skeptical of the value of individual dental insurance, but said patients should also be careful about a plan. dental membership because they are generally not supervised by the states.
“People should be aware that this is a generally unregulated area, so the buyer should be wary,” he said.
Before subscribing to a membership plan, consumers should ask what the dentist charges for the procedures so that they know not only the discount but also the actual cost out of pocket. In some cases, membership plans are a viable option.
“If you go with an established practice and the costs are reasonable and within your budget, it may make sense,” to sign up, he said.
Vanessa Bernal, director of the Winter Garden Smiles office in central Florida, said many freelance and small-business patients have signed up to the firm’s membership plan.
“They don’t have employer coverage, and if they were going to buy it themselves, they would face a waiting period, as our discounts start immediately,” she said.
Winter Garden Smiles has enrolled more than 370 patients in its plan, which costs $ 245 per year for children and $ 285 for adults. The office has abandoned three small insurance networks since launching its own plan.
Many of the plans offered across the country are very similar to dental insurance. Patients typically pay between $ 300 and $ 400 per year at the dental office. In return, they receive certain preventive services and other procedures free of charge.
But membership plans don’t have the annual deductibles or waiting periods that can make individually purchased dental insurance unattractive. Another deterrent to traditional insurance plans is their maximum benefit limits, typically $ 1,200 to $ 1,500 per year. In comparison, patients with memberships can use the discounts for unlimited treatment.
About half of Americans have dental coverage in the workplace. These policies are generally the best buy for those who benefit from them. But Medicare doesn’t provide dental coverage, and most state Medicaid programs don’t cover adult dental coverage.
But for patients without an employment-based plan, purchasing an independent dental policy is expensive, and unlike purchasing health insurance, it is not clear whether the benefits outweigh the benefits. costs. This is because dental costs are not as financially catastrophic as hospital bills, which can run into the tens of thousands of dollars.
Annual dental insurance premiums generally range from $ 400 to $ 700. Most plans cover all costs for preventative services, such as cleanings. For minor procedures, like fillings, plans typically pay 70-80%. For major procedures, such as crowns, plans often pay around 50 percent of the cost, which is even more than what membership plans cover. Insurance plans, however, have often negotiated prices with dentists, so the liability of plan members is also reduced.
Melissa Burroughs, who leads an oral health for all campaign for the Families USA advocacy group, said dental membership plans can help some people, but they don’t solve the problems of high dental costs and insurers. treat tooth coverage differently. than for the rest of the body.
“I don’t think these plans are the answer, and they certainly don’t meet the standard of making care truly affordable for many people,” she said.
Megan Lohman, CEO of Plan Forward, an Indianapolis company that helps set up membership plans, said many insurers had not increased reimbursement rates in years, encouraging dentists to come forward. own plans. “We’re not seeing dental insurance go away, but patients and dentists just needed an alternative,” she said.
Patients say they appreciate that membership services are cheaper than when they pay strictly out of pocket, and prepayment for services motivates them to seek preventative services.
“The membership plan keeps me on track because it’s almost like I have a down payment on my care,” said Christina Campbell, 29, of Hamden, Connecticut. She had dental coverage under her mother’s policy until she was 26, then started shopping for her own coverage.
When her dentist, Kevin D’Andrea, mentioned her plan, she decided it looked too good to pass up. With the membership, she said, she’s back for semi-annual checkups and cleanings, and she no longer hesitates when it’s time for x-rays. Campbell, who runs a winery, pays $ 38 a month.
Holly Wyss, 59, of Greenwood, Indiana, found dental insurance too expensive, so she signed up for a $ 300 per year membership plan through her dentist, David Wolf. The discounts saved her several hundred dollars on two crowns, she said. “For me, it’s a no-brainer,” said Wyss, a nurse practitioner. “It has been a godsend for me because everything I pay is out of my pocket. “
Among the groups without dental insurance that have recently gained attention are those covered by traditional health insurance. However, many private Medicare Advantage plans offer dental benefits. These plans provide coverage only in certain dental offices, have a premium, and often only cover a small portion of patient costs. The average coverage limit is $ 1,300, and more than half of enrollees are in plans with a $ 1,000 limit on benefits, according to a KFF report.
Older Americans need dental coverage
President Joe Biden and Congressional Democrats have proposed adding a dental benefit to Medicare, along with other health care initiatives, as part of a $ 3.5 trillion human infrastructure plan that lawmakers are seeking to pass this fall. The bill released by the House Ways and Means Committee this month would still let beneficiaries pay 20 percent of the costs of preventive services such as exams and between 50 percent to 90 percent of the costs for some procedures. And the law, if passed, could take five years or more to implement.
The need among older Americans is great.
Almost half of Medicare beneficiaries, or 24 million people, did not have dental coverage in 2019, according to KFF. In 2018, nearly half of all Medicare beneficiaries had not seen a dentist in the past year (47%), with higher rates among African Americans (68%) and Hispanics ( 61%).
D’Andrea, the dentist in Hamden, Connecticut, said the membership plan he launched in 2020 is building patient loyalty.
“Patients know in advance what their personal expenses are and they don’t have to wait and see what their insurance will cover,” he said. “It’s like a game that insurers play, keeping us on hold for an hour to get pre-approvals. We pull enough teeth in the office, and it’s the same with pulling information out of them.