Teeth Wisdom:
Common Misperceptions
of Dental Coverage
While medical coverage will be the primary
focus of health care deliberations in Congress,
implications for dental coverage and oral health
should not be overlooked. Yet, misperceptions
about dental coverage persist today when, in
fact, the dental benefits system works well—
and much differently from medical coverage.
Misperception #1: It’s just dental. Misperception #3: Care equals treatment.
There’s no denying that medical coverage is One of the key shifts in health care is an evolving
extremely important for good health and financial focus from treatment to prevention and wellness
security. But dental coverage is also important for programs. Dental coverage has long been at the
oral health and overall health. forefront of prevention-focused care. With dental
coverage, regular check-ups are almost always 100
Poor oral health, a lack of dental care and untreated
percent covered—there’s almost never a co-pay
oral diseases can adversely affect an individual’s
that could discourage a dental visit. And, dental
ability to speak, smile, kiss, chew, maintain proper
offices do a good job promoting prevention-based
nutrition, attend school or go to work. Statistics
care by encouraging patients to schedule their next
show that dental-related absences total more than
appointment before they leave the office.
164 million work hours for adults each year.1
Misperception #4: Building one provider
Misperception #2: It costs more than
network is the same as building another.
it’s worth. Compared to medical doctors, relatively few
Dental health is very important, but the simple fact
dentists work in group practices. So while medical
is that people, particularly children, with dental
networks are customarily built on a group level,
coverage are more likely to receive care. In fact, 81
dental care networks are chiefly built and managed
percent of individuals with dental benefits reported
one dentist at a time—a labor-intensive activity
seeing a dentist twice a year or more, while only 34
requiring expertise in how to recruit and maintain
percent of uninsured individuals reported the same
dentist participation. A stand-alone dental carrier’s
frequency of seeking preventive care.2
experience with—and commitment to—this kind of
Furthermore, over 90 percent of all systemic one-to-one engagement forges strong relationships,
diseases, including diabetes, leukemia, cancer, heart fosters loyalty and encourages compliance among
disease and kidney disease, have oral characteristics its network providers.
that can be detected during an oral exam.3 A dentist
may be the first to spot warning signs of a potential
systemic disease during a regular checkup. 4 4 4 4 4 4 4 4 4 4 4 4
Misperception #5: One insurance claim is Misperception #7: Dental coverage costs
the same as another. are out of control.
With medical coverage, claims are often lower While double-digit increases in medical premiums
frequency but higher cost; in dental, it’s just the have been common, dental premiums have
opposite. The prevention-based model encourages increased only 4–8 percent annually over the past
frequent care and lower claims costs to avoid more decade.4 In the last 10 years, medical premiums
costly treatment. Dental benefits specialists can have risen an average of 11.4 percent annually.5
optimize staffing to handle high-frequency, low-cost
claims—and employ a dental director with expertise Misperception #8: You might as well get
in understanding the nuances of dental claims. dental with your medical.
While medical carriers would certainly employ You can visit a buffet when you’re hungry, but you
medical directors for similar reasons, they may don’t expect to get the best of anything there. It’s
or may not have specialized expertise on the the same with medical and dental coverage.
dental side. Stand-alone dental specialists focus their efforts
to offer the best in the category. That’s why today’s
Misperception #6: So-called “market dental consumers stay with specialists like Delta
reforms” make sense for all types Dental year after year. In fact, each year, Delta
of coverage. Dental companies typically retain better than 97
Medical and dental coverage are very different— percent of their customers.6
so different that Congress has formally designated
dental as an “excepted benefit.” Excepted benefits Misperception #9: All carriers or insurance
are products that are not designed to provide companies are the same.
comprehensive medical coverage, but rather Most companies in the Delta Dental System are
to supplement that coverage. This “excepted” organized as not-for-profits with a mission to
designation is specifically intended to help improve the oral health of the communities they
keep these kinds of benefits affordable. As health serve. By providing cost-effective dental coverage to
care reform is implemented, the “excepted benefit” more than 56 million Americans and by helping to
designation remains vital. While market provide education about and access to oral health
reforms such as prohibiting insurers from care among underserved populations, Delta Dental
establishing annual/lifetime payment caps or is making a real difference. In fact, Delta Dental
dropping coverage may make sense on the medical member companies have provided grants and
side, they threaten the affordable preventive-care donations over the past five years totaling
model already established on the dental side. $250 million.
The rarity of catastrophic dental claims is further
evidence of the need to treat medical and dental Questions?
coverage differently. For more information, please visit us online:
Indiana: www.deltadentalin.com
Kentucky: www.deltadentalky.com
Michigan: www.deltadentalmi.com
New Mexico: www.deltadentalnm.com
North Carolina: www.deltadentalnc.com
Ohio: www.deltadentaloh.com
Tennessee: www.deltadentaltn.com
1 U.S. Department of Health and Human Services, National Call to Action to Promote Oral Health, NIH Publication No. 03-5303, Spring 2003.
2 The Long Group Retail Dental Insurance Consumer Acceptance Survey, June 2009. (Findings are based on a sampling of consumers ages
25–65 within the top 25 dental markets.)
3 Academy of General Dentistry’s Know Your Teeth, October 2008.
4 Aon Spring Trend Survey, 2009.
5 Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000–20ı0.
6 Delta Dental Data, 2009.
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