How dental insurance coverage is evolving: Q&A with NADP Executive Director Mike Adelberg
November 7, 2023
Recent research shows that the percentage of PPO plans offering higher annual maximums for dental plans has increased over the last several years, according to Michael Adelberg, executive director of the National Association of Dental Plans.
Mr. Adelberg recently spoke with Becker’s about some of the trends taking place among dental insurers and coverage plans.
Note: Responses were lightly edited for clarity and length.
Question: What trends have you been seeing with annual maximums?
Michael Adelberg: I’m disappointed when I hear the statement that annual maximums are not changing. NADP has been conducting an annual report on the state of dental insurance products since 2012. I’ve seen a trend line in the annual maximums. Reasonable people can argue about the pace of change, but there is real change. If we pick a year, let’s say 2017, only 5% of PPOs had very high annual maximums of $2,500 or more. That’s now 15%. So the number of highly protective annual maxes has tripled since 2017. There’s absolutely a trend toward greater protection in annual maximums.
If we talk about annual maximums of $1,000 or lower, it still is a chunk of the market. In 2014, when this trend line began, that was over about 53% [of the market], and it has dropped from 53% to roughly 34%. There is real change. That’s not to say there aren’t some plans that still have $1,000 [annual maximums.] There are obviously some, but it’s gone from being the majority of the market to being a distinct minority.
Q: What are some other trends among dental insurers that you are following?
MA: Many of my members now offer additional benefits for people with certain chronic conditions. For example, people with diabetes get extra teeth cleanings. There is also an increasing number of plans that let people roll over unspent dollars from year to year. Dental plans are not seeking to squeeze down the generosity of a particular benefit. Dental plans will offer what the employer pays for. Dental plans are perfectly happy to offer very rich dental benefits when employers pay for it. Ultimately, that’s what guides the richness of the benefit. Meanwhile, dental plans typically continue to pay 100% for the preventive services that are central to oral health.
Q: Have you heard from insurers about some of the criticisms they get from dental providers?
MA: What I think my members would tell you is, first, they really try hard to meet the needs of their partners. It’s also worth noting that there are certainly many dentists who are doing well inside of provider networks and you don’t hear from them. You tend to hear from the people who are the least happy, not the people who are content. The segment of the practicing dentists you hear from is not necessarily a representative sample.
Having said all of that, it’s harder to be a small practice than in the past for many reasons, including reasons that have nothing to do with dental insurance. There is an increasing business case to be made for practicing within a group or hiring some type of management platform to deal with the business side of the practice. For the people who are choosing not to go that route, it might get harder for them. I don’t doubt that. I’d say the same thing about primary care physicians, physical therapists, optometrists or pretty much any type of provider. It’s harder to be a solo practitioner.