It’s true. Many dental plans look similar. Especially when looking at the basics, like the annual maximum and the percentages covered for services. For example, you may hear people talk about a “1,500, 100, 80, 50” plan design. What does that mean?
For a plan like this, it means the annual maximum is $1,500. That’s how much the dental plan will pay out for dental services before your employee has to start covering the rest. Now for the 100/80/50 part. Preventive care (teeth cleanings, exams, X-rays, etc.) is covered 100 percent, basic services (fillings, root canals, extractions, etc.) at 80 percent and major dental services (crowns, implants, etc.) at 50 percent.
The challenge with that information and a bottom line cost for the plan is that it leaves several unknowns. I welcome transparency. My team at HealthPartners is very upfront and open about our plans and happy to discuss details.
Here are a few insider tips on what to avoid when choosing a dental plan for your organization.
1. Focusing simply on the bottom line
Yes, it plays a big role in your decision, but it’s what goes into that number that counts. If a rate looks too good to be true, then it probably is. A low rate may mean that some services are excluded from the plan design under the 100/80/50 in my example. If a plan doesn’t include dental implants, for instance, the total cost may be more when adding premium and out-of-pocket costs. If there’s a low rate, ask how the renewal rate is calculated the following year. Is there a rate guarantee that goes beyond one year? If the rate jumps significantly, you’ll have to decide whether or not you want to switch your plan again.
Your takeaway: A lower rate isn’t always the best deal when looking at the total value of a dental plan.
2. Not asking how discounts are calculated
When looking at dental plans, you’ll typically see companies show their dental discount rate. For example, an insurance company may say their dental discount is 25 percent.
That number usually represents the percentage of savings below the average cost of dental procedures for a particular geographical area. Dental insurers work with dentists to offer a lower cost for their members. That’s the discount. And you’ll likely see from 20 to 30 percent savings. The challenge is that not all dental insurance companies calculate discounts the same.
A “30 percent discount” may be their national savings rate rather than a state or even county rate. The cost of dental services, as well as dentists’ willingness to give discounts, varies across the country, so a national savings may not be relevant.
Or it can mean the percentage is for the best-case discount in a location, which may not be a true reflection of the average discount, or perhaps a very narrow network of dentists. Other times, the percentage can be the savings compared to the 80th percentile of what’s usual and customary (referred to as the U&C and is used to show a fee level that 80 percent of dentists in a location charge less than).
Your takeaway: It’s best to take network savings with a grain of salt. Ask how the rate is calculated. It’s OK to ask until you understand the number.
3. Not questioning network size
Three items make a network valuable: dentist fees, the discount rate and how the dentist provides care (often referred to as the “care agenda”). When a dentist charges less than another dentist does for a filling, and an insurance plan offers a strong discount for that filling, it reduces total cost. It’s even better if that dentist is able to use a filling to fix the tooth rather than a more expensive crown. That’s where the care agenda matters and helps to reduce the total cost of care.
How is a dental network built? A dental network is made up of dentists contracted by the insurance carrier to discount the cost of their services to members. That’s the dental discount.
Here’s where it gets challenging. Insurance carriers may have different types of networks. Some give better discounts than others. Generally, a PPO (Preferred Provider Organization) network will provide the best discounts. At HealthPartners, our PPO network is the largest in Minnesota. Others may have a larger overall network outside of a PPO, but if getting the best discount matters, then a PPO network is your best option.
Your takeaway: When working with an insurance company, ask about network savings rather than just network size. A PPO network gives better discounts. Question the care agenda and find out how the carrier is helping you reduce the cost of care.
4. Forgetting to consider additional benefits
What else does the plan have to offer? Value really does matter when choosing a dental plan. Extra perks and benefits can save employees money and better yet, keep them healthier. And healthy employees reduce your total costs.
For example, not all plans have a benefit that covers extra gum treatment for diabetics or those who are pregnant and at risk of gum disease. Both of these groups benefit from keeping their gums healthy and free of bacteria. If a carrier says they provide extra coverage for diabetics at risk of gum disease, be sure to ask a few more questions.
Ask specifically what the services are and what, if any, will the plan cover. Extra teeth cleaning doesn’t go as far as specialty services like root planing and scaling, which HealthPartners covers 100 percent at in-network dentists. For example, an extra teeth cleaning may be $100 while root planing and scaling can cost $1,250 or more. Having that service covered 100 percent makes a big difference for both cost and patient health.
Dental care for kids that’s 100 percent covered is another item to consider. At HealthPartners, we call this the Little PartnersSM Dental benefit. It keeps kids under 12 healthy and their parents’ wallets closed.
Other valuable perks can include discounts on hearing aids, gym memberships, glasses, fitness equipment and much more. Ask what’s available.
Your takeaway: Always ask about additional benefits. You should be getting more than just the basics.
5. Putting aside the onboarding process and not knowing about plan administration
There’s nothing more frustrating than going with a new dental insurance company and having them botch onboarding and plan administration. You want easy.
Going with a dental plan is at minimum a yearlong commitment. What should you look for? Online tools, personal help and great reporting all go a long way to help you make better decisions. If your organization has both medical and dental with HealthPartners, you get one website, one Member Services line, one statement, integrated reporting and one enrollment.
Your takeaway: Value your administration time. Question your dental carrier about how they can help you save time and make it easy to run your business.
6. Overlooking the importance of customer service
When one of your employees calls with a question about their plan or a claim, you want the interaction to be fast and accurate. And of course, getting a live person to talk to is better than a robotic, automated system.
The service you get makes a big difference. It keeps employees happy and you free of complaints. At HealthPartners, our Member Services team resolves 95 percent of issues on the first call.
Plus, we take the member out of the middle by working with network and non-network providers to file claims directly with us. That’s simple. And a better experience for everybody. Service is a priority and we’ve earned the highest overall member plan rating among Minnesota health plans for 10 years running.*
Your takeaway: Great customer service matters. It saves everyone time and helps to keep everyone happy.
*According to the 2007-2016 Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).