White House Drops Bid To Add Dental, Vision Benefits To Traditional Medicare In Pared Down Infrastructure Bill

White House drops bid to add dental, vision benefits to traditional Medicare  in pared down infrastructure bill | FierceHealthcare

Source: Fierce Healthcare, by Robert King

The White House released an updated framework for its trillion-dollar infrastructure package that closes the Medicaid coverage gap and extends enhanced subsidies on the Affordable Care Act’s exchanges.

But it drops expanding dental and vision benefits after centrists called for paring down the overall cost of the package, which originally was proposed for $3.5 trillion.

The framework also doesn’t include legislation to give Medicare the power to negotiate for lower drug prices, but senators say that it would eliminate a rule that gets rid of the safe harbor for Part D drug rebates.

The new framework comes as Congress is hurriedly working to add in details on the package, including what must be taken out to meet the lower price tag.

When the package was first introduced, Democrats hoped to add dental and vision benefits alongside hearing to traditional Medicare. However, the framework released would only cover hearing benefits.

“Only 30% of seniors over the age of 70 who could benefit from hearing aids have ever used them,” the framework said.

There have been concerns over the cost of adding dental benefits. Biden even hinted during a town hall on CNN last week that adding the benefits would be a reach due to concerns from centrists.

The framework does include a provision to close the Medicaid coverage gap for residents in states that have not expanded Medicaid under the ACA, a major priority for the newly elected Democratic Sens. Ralph Warnock and Jon Ossoff of Georgia, which has not expanded Medicaid.

Warnock and Ossoff had pushed for legislation to create a program similar to Medicaid to create coverage for those in the gap. But the framework instead opts for offering premium tax credits to up to 4 million uninsured people.

“A 40-year-old in the coverage gap would have to pay $450 per month for benchmark coverage—more than half of their income in many cases,” the White House said. “The framework provides individuals $0 premiums, finally making healthcare affordable and accessible.”

The coverage gap proposal has gotten pushback from key centrist senators, including Sen. Joe Manchin, D-West Virginia, whose state has expanded Medicaid back in 2014 and was concerned about fairness as states have to cover 10% of the expansion costs now.

Ossoff pushed back on those concerns by noting that currently, residents in his state aren’t getting the healthcare that they pay for.

“Georgians are paying federal taxes but not getting healthcare,” he told Fierce Healthcare on Tuesday. “So as a matter of fairness our constituents are paying for this healthcare but not receiving it.”

The legislation would also boost income-based subsidies for people who buy ACA insurance, reducing premiums for more than 9 million people who buy marketplace coverage by an average $600 per person, the White House said.

“Experts predict that more than 3 million people who would otherwise be uninsured will gain health insurance,” the framework release said.

The American Rescue Plan Act boosted income-based subsidies but only through 2022. The framework release does not specify how long the enhanced subsidies will remain in place if it becomes law.

The exact details of the package could change as lawmakers seek to put the finishing touches on the package.

A key unknown is how the package will tackle drug prices. Democrats are haggling over granting Medicare the power to negotiate for lower prices but also how broad that power should be.

Several Democratic senators said they were disappointed that drug price negotiations got left out of the final framework.

But Senate Finance Committee Chairman Ron Wyden, D-Oregon, said that efforts on drug prices aren’t dead yet.

“We’re staying at it. I’ve had a number of conversations on that this morning and that is very much an active effort,” he said.

Hygienists Brace for Pitched Battles With Dentists in Fights Over Practice Laws

Hygienists Brace for Pitched Battles With Dentists in Fights Over Practice  Laws | Kaiser Health News

Source: Kaiser Health News, by Giles Bruce

This year, the Illinois legislature was considering measures to expand oral health treatment in a state where millions of people live in dental care deserts.

But when the Illinois State Dental Society met with key lawmakers virtually for its annual lobbying day in the spring, the proposals to allow dental hygienists to clean the teeth of certain underprivileged patients without a dentist seemed doomed.

State Sen. Dave Syverson, a Republican legislative leader, warned against the bills even if they sounded minor. “It’s just getting the camel’s nose under the tent,” he said in an audio recording of the meeting obtained by KHN. “We’ll have, before long, hygienists doing the work that, if they wanted to do, they should have gone to dental school for.”

The senator added that he missed “the reception and the dinners that you guys host” and the “nice softball questions that I usually get” from the dental society’s past president, who happens to be his first cousin.

The bills never made it out of committee.

The situation in Illinois is indicative of the types of legislative dynamics that play out when lower-level health care providers such as dental hygienists, nurse practitioners and optometrists try to gain greater autonomy and access to patients. And the fate of those Illinois bills illustrates the power that lobbying groups such as the Illinois dental society have in shaping policies on where health professionals can practice and who keeps the profits.

“There’s always a struggle,” said Margaret Langelier, a researcher for the Center for Health Workforce Studies at the University of Albany in New York. “We have orthopedists fighting podiatrists over who can take care of the ankle. We have psychiatrists fighting with clinical psychologists about who can prescribe and what they can prescribe. We have nurses fighting pharmacists over injections and vaccinations. It’s the turf battles.”

In 2015, the Illinois Dental Practice Act was revised to let hygienists treat low-income patients on Medicaid or without insurance in “public health settings” — such as schools, safety-net clinics and programs for mothers and children — without a dentist examining them or being on-site. Besides doing cleanings, the hygienists can take X-rays, place sealants and apply fluoride.

This year, lawmakers proposed bills that would have expanded those settings to include nursing homesprisons and mobile dental vans.

The state dental society, in a memo to members, wrote that the fact it took years for hygienists to develop their public health training program shows “they have no real interest in providing access to care to needy patients.”

As it is, Illinois trails many other states in allowing dental hygienists unsupervised contact with patients. In Colorado, on the extreme end, hygienists can own practices.

“It’s just the nature of the beast politically in Illinois. The dental lobby isn’t as strong in those other states,” noted Margaret Vaughn, executive director of the Illinois Rural Health Association. “The Illinois State Dental Society is much more powerful, and they’re much more organized than the hygienists are politically.”

From 2015 to 2019, the dental society spent more than $55,000 on lobbying, for its annual gathering and meals for lawmakers, typically hosted at a swanky Italian spot near the state Capitol in Springfield, according to public disclosures. In the same period, the Illinois Dental Hygienists Association reported spending nothing in its lobbying reports. (Neither group has listed any expenditures since the beginning of 2020.)

The dental society has two exclusive lobbyists and four lobbying firms on contract, state records show. The hygienist group, meanwhile, employs no lobbyists and contracts with just one firm.

The dental society donates generously to both Republicans and Democrats. Its political action committee had nearly $742,000 in cash on hand as of June 30, according to Reform for Illinois’ Sunshine Database. While the PAC has given $4,050 since 2014 to support the campaigns of state Sen. Melinda Bush, a Democrat who sponsored the nursing home bill, the database shows it has contributed far more to help elect Syverson, the senator who spoke at the conference. It has given more than $123,000 to his campaigns since 1999, with bigger annual gifts than to Bush.

“I receive contributions from many groups on both sides of issues,” Syverson emailed KHN. “They are not contributing to influence my vote on a particular bill. In fact, if a PAC sent a check while we were negotiating or voting on an issue they are involved with, I would not accept it.”

The hygienists’ PAC gave $1,100 to the campaign committee of Bush, according to the database, but nothing to Syverson. Bush did not respond to requests for comment.

“The bottom line is, if you don’t have a healthy mouth, you don’t have a healthy body,” said Ann Lynch, director of advocacy and education for the American Dental Hygienists Association. “It only makes sense that we would remove any barriers that do not allow a licensed health care provider to practice at the top of their scope.”

But Dave Marsh, a lobbyist for the Illinois dental society, said it would be dangerous for hygienists to treat nursing home residents, who are often elderly and sick.

“I just don’t feel anybody with a two-year associate’s degree is medically qualified to correct your health,” Marsh added. “They’re trained to clean teeth. They take a sharp little instrument and scrape your teeth. That’s what they do. That’s all they do.”

He said the problem is not a shortage of dental professionals but, rather, a lack of dentists who can afford to accept Medicaid patients — and “nobody wants to raise taxes to actually be able to reimburse” dentists at higher rates.

He also pointed to the scarcity of research on the benefits of dental hygienists having more professional freedom.

Langelier acknowledged that little academic literature exists on this topic, in part because of inadequate data collection on oral health. But in 2016, a study she co-authored in Health Affairs found that, as dental hygienists gained more autonomy, fewer people had teeth removed because of decay or disease. And she said Medicaid data shows more children had dental visits as hygienists expanded their practice.

“I don’t want this to be acrimonious,” said Laura Scully, chair of the access-to-care committee of the state hygienists association. “I would like it to be more of a collaboration, because truly that’s what this is about: getting together so we can help more people.”

Karen Webster works as a dental hygienist for the Tri City Health Partnership, a free clinic in St. Charles, Illinois, about 40 miles west of Chicago. In the past, she could only briefly screen patients before scheduling them with one of the center’s volunteer dentists, often months out.

“Imagine if you had a toothache and the doctor couldn’t see you that day,” she said, noting that her patients have low incomes. “They can’t afford the services. They wait till something hurts.”

But since becoming a public health dental hygienist, Webster now does immediate cleanings, takes X-rays she sends to teledentists for exams, and applies a solution called silver diamine fluoride that can halt tooth decay.

“The whole thing, start to finish, it’s just a lot more efficient,” she said.

KFF: Analysis Finds Out-Of-Pocket Spending On Dental, Hearing In Medicare Far Outweighs Vision Benefits

KFF: Analysis finds out-of-pocket spending on dental, hearing in Medicare  far outweighs vision benefits | FierceHealthcare

Source: Fierce Healthcare, by Robert King

Out-of-pocket spending for hearing and dental care far outpaced spending for vision care among Medicare beneficiaries, a new analysis found.

The analysis, released Tuesday by the Kaiser Family Foundation, examines out-of-pocket spending in 2018 and 2019 on traditional Medicare and Medicare Advantage on the three benefits. It comes as Congress is contemplating adding the three benefits to traditional Medicare as part of a $3.5 trillion infrastructure package.

“While some Medicare beneficiaries have insurance that helps cover some dental, hearing, and vision expenses (such as Medicare Advantage plans), the scope of that coverage is often limited, leading many on Medicare to pay out-of-pocket or forego the help they need due to costs,” Kaiser said in the analysis.

The largest source of out-of-pocket spending was hearing care, where beneficiaries spent $914 on average in 2018, Kaiser found.

Out-of-pocket spending on dental was $874, and vision care was $230.

But dental care was by far the most used benefit, with 53% of Medicare’s beneficiaries employing it. Vision care was the second most-used benefit with 35% of beneficiaries employing the service, and hearing care was used by 8%.

Kaiser found that in 2018, a small share of beneficiaries incurred the highest out-of-pocket costs for dental and hearing care.

Half of the beneficiaries that got dental services had out-of-pocket spending below $244 in 2018 as well as $130 for vision and $60 for hearing benefits.

But a smaller share of beneficiaries incurred high out-of-pocket costs. Kaiser found that beneficiaries in the top 10% of out-of-pocket costs spent $2,136 or more for dental care, $3,600 for hearing and $585 for vision care.

The higher costs were likely tied to costly equipment like hearing aids or pricey dental procedures such as implants, Kaiser said.

Overall, beneficiaries enrolled in MA plans spent less out-of-pocket for dental and vision than traditional beneficiaries, but there was no difference in spending on hearing care.

“Both groups spent substantially more for dental and hearing services than vision services,” the analysis said. “For dental services, average out-of-pocket spending was $766 among beneficiaries in Medicare Advantage and $992 among beneficiaries in traditional Medicare.”

The analysis also found problems with some beneficiaries getting access to care.

“About one in six Medicare beneficiaries reported in 2019 that there was a time in the last year that they could not get dental, hearing or vision care, and among those who reported access problems, cost was a major barrier,” Kaiser said.

The analysis comes as Congress is debating how to add dental, vision and hearing benefits to traditional Medicare as part of a $3.5 trillion infrastructure package.

“Expanding Medicare coverage for dental, hearing and vision services and making lower-cost hearing aids available would address significant gaps in coverage and could alleviate cost concerns related to these services for people on Medicare,” Kaiser’s analysis said.

Dentists’ Organization Fights Plan To Cover Dental Benefits Under Medicare Expansion

Dentists' Group Fights Plan to Cover Dental Benefits Under Medicare - WSJ

Source: MarketWatch, by Julie Bykowicz

The American Dental Association is mobilizing its 162,000 members to fight a proposal to include dental coverage for all Medicare recipients, opposition that could prove pivotal as Democrats look to make cuts in their $3.5 trillion domestic policy agenda.

Giving dental, vision and hearing benefits to the 60 million older and disabled Americans covered by Medicare will provide needed care to people who otherwise might not afford it, supporters say.

The ADA contends that Medicare won’t reimburse enough to cover their costs and is pushing an alternative plan that would limit benefits to the poorest Medicare recipients. It is asking members to contact lawmakers in opposition.

“There aren’t endless amounts of federal dollars, so the question is how do you maximize dollars to do the most good?” said Michael Graham, the ADA’s senior vice president for government and public affairs. “If you don’t focus on low-income seniors, you are just wasting your money.”

4 Reasons Why Teledentistry Will Help Change Oral Health

4 Reasons Why Teledentistry Will Help Change Oral Health | FierceHealthcare

Source: Fierce Healthcare

Dental care in the United States has been changing, gradually, in the last decade. Like the overall health care system, new treatments, new payment models, and new technologies have been shifting providers away from the surgical management of oral disease to a greater focus on prevention and health promotion.

Then the COVID-19 pandemic hit the country, and, by necessity, the industry stepped on the gas pedal. Questions became realities. Promising ideas became protocols. The shift accelerated.

And, now, the industry is faced with a question: What will the new future of care look like in—and beyond—the dental chair in a still uncertain future?

Teledentistry will be part of that answer.

Teledentistry is a virtual set of tools that allows for electronic communication and delivery of health services. It promotes equitable access to oral health care and represents an expansion of existing care, not a new form of care. Whether provided within a dental office, in a community setting, or from a patient’s home, the tools enable care and communication when patients are not or cannot be seen in a traditional office setting with a dentist present.

Examples of Teledentistry During the Pandemic

Teledentistry took many different forms during the pandemic, guided by a creative, diverse dental workforce. Community-based programs, health centers, health systems, private practices, and others made use of teledentistry to provide care to patients in various settings to reduce barriers to care. For example:

  • * In Oregon, a rural teledentistry program enabled dental hygienists to assess schoolchildren’s mouths visually, chart likely areas of tooth decay, take pictures and X-rays of a child’s mouth, and use laptops to transmit this information to a dentist in another location who reviewed these materials and developed a treatment plan for each participating child.
  • * In California’s Virtual Dental Home (VDH) model, specially trained dental hygienists and assistants collect dental records and provide preventive care for patients in schools, Head Start programs, and nursing homes. Information was then sent through a secure telehealth system to a dentist at a clinic or dental office who determined a diagnosis and developed a dental treatment plan.
  • * In Missouri, private and public health dentists worked with dental hygienists under general supervision to provide extended hours and satellite office coverage using teledentistry when the dentist was out of the office. In this example, a dental hygienist used asynchronous teledentistry to capture all needed diagnostic data to establish new patients for examinations and to maintain the health of existing patients.

This dental care delivery model is especially useful, as it helps to create equity in oral health by extending the availability of dental care outside of the constraints of the dentist’s availability.

Looking to the Future of Teledentistry

While its use has expanded dramatically during the pandemic, teledentistry should continue to serve as a tool to improve access to care and health outcomes even after the pandemic ends. It can also provide patients with an opportunity for a greater role and voice in their own care.

So why is teledentistry here to stay?

  1. 1. Teledentistry helps states weather crises. Whether in the midst of an infectious disease outbreak or natural disaster, teledentistry will help ensure that people do not lose access to care. In a survey from August 2020, for example, nearly a quarter of dental providers were seeing patients via telehealth platforms. Teledentistry allows people to receive care in compliance with social distancing guidelines and reduces the number of visits to hospital emergency departments (EDs), which can easily be overwhelmed during a crisis.
  2. 2. Teledentistry can help reduce costs. In one study in 2018, patients with a teledentistry visit cost 10% less to treat than patients who didn’t use teledentistry. Teledentistry can also keep patients out of the emergency department (ED), where care generally costs more and focuses on managing pain and infections rather than addressing the underlying oral health condition. Because EDs often lack systems for oral health provider referrals, many patients return to the ED for the same problem.
  3. 3. Teledentistry expands access to care.Adults benefit from teledentistry models that offer them flexible options for receiving care, consultations with dental providers, and educational information about their oral health. Providing more Americans with access to dental services and oral health education leads to healthier mouths, which, in turn, strengthens overall health.
  4. 4. Patients are embracing teledentistry. Another recent CareQuest Institute survey demonstrates that patients are satisfied with their teledentistry experiences and appreciate the flexibility it offers, enabling them to secure oral health services without the need for a face-to-face appointment. In fact, 86% of patients said they were satisfied with their overall teledentistry experience and would recommend teledentistry to another person.

As California Pours Money into Denti-Cal Reform, State Sees Modest Improvements

Image result for As California Pours Money into Denti-Cal Reform, State Sees Modest Improvements images

Source: California Health Report

California has given dentists nearly $130 million in incentive payments in the last two years in return for treating more low-income children.

While only 45.3 percent of children with Denti-Cal, the state’s low-income dental program, received preventative care at a dentist’s office in 2017, that’s 20 percent more than did before the state improvements began. In 2014, two years before the Dental Transformation Initiative launch, less than 38 percent of children in Denti-Cal received any sort of preventative care.

The number of dentists providing preventative care services to Denti-Cal enrollees also increased more than 7 percent, and the number of individual services provided has climbed by 14.8 percent.

“We think it’s a great improvement,” said Eileen Espejo, senior managing director for media and health policy for Children Now, an Oakland-based advocacy group. “Any way to increase utilization is critical.”

About half of California’s children are enrolled in Denti-Cal, the Medi-Cal dental insurance program.

In addition to increasing preventative dental care, the state’s Dental Transformation Initiative is focused on continuity of care, assessing and managing tooth decay, and local pilot projects. Preventative treatments that fall under the continuity of care category have increased 27.7 percent between 2014 and 2017. A total of $2 million in incentive payments for assessing and reducing the risk of tooth decay began in 2017, according to the state Department of Health Care Services, which oversees Denti-Cal.

“The Department of Health Care Services is satisfied with what has been accomplished under the Dental Transformation Initiative,” Tony Cava, an agency spokesperson, said in an email.

Paul Glassman, a dentist, professor at the University of the Pacific in San Francisco and principal investigator for all the Dental Transformation Initiative subcontractors, noted that the program got off to a slow start in terms of handing out contracts.

“It’s turning out to be less than a four-year initiative,” Glassman said. “Things are going better now.” The initiative ends in 2020.

Espejo noted that the dozen local pilot projects, which the state has spent $16.3 million on to date, have shown some success. One of the pilots, known as a virtual dental home, is being deployed in five counties. Dental hygienists use portable equipment to x-ray children in schools, and the x-rays are electronically transmitted to dentists for further examination. The hygienists can also perform what are known as an interim therapeutic restoration—essentially a filling that can be inserted without drilling.

Glassman, who oversaw a six-year proof-of-concept project for virtual dental homes before they were operated under the initiative, noted there are about 40 hygienists working in conjunction with about 30 dentists and federally qualified health clinics to provide the virtual home care. The project is working as well in cities as it is in rural areas.

“About two-thirds of very low-income kids could be kept healthy without seeing a dentist,” Glassman said.

According to Espejo, there are also promising pilots in place to train primary-care physicians to check on the oral health of their pediatric patients, and one at UCLA that analyzes electronic medical records for patients in need of potential dental care. Specific data about the efficacy of the pilots was not immediately available. Glassman noted that the gathering and transmission of data to the state for the pilot projects is an issue that has yet to be fully resolved.

The Health Care department acknowledges that more challenges for the initiative lie ahead. Cava noted that one of the biggest challenges is changing perceptions toward preventative dental care.

“The general public doesn’t normally prioritize the mouth and dental care for preventive maintenance like they do for medical care,” he said. “People tend to go to the dentist when they are in pain versus routine care. DHCS is trying to change that dynamic.”

For 2019, the agency has expanded exams for dental decay into 18 additional counties, for a total of 29, and increased focus on continuity of care in 19 new counties, for a total of 36.

However, whether the initiative will be a long-term success remains to be seen. While Cava noted that the agency will issue a comprehensive report in 2021, there is some skepticism about whether or not any progress will be sustainable.

Both Espejo and Glassman agree that many dentists in California remain reluctant to treat Denti-Cal enrollees, primarily because the extra reimbursement from government programs tends to be transient. Should the hundreds of millions being spent under the initiative disappear, it is quite possible the recently recruited providers will retreat.

“There are still a lot of lessons to be learned about what is working and not working,” Espejo said.

Fewer Older Americans Have Dental Insurance

Only 12% of older Americans have dental insurance and fewer than half visited a dentist in the previous year, according to a study of Medicare beneficiaries by the Johns Hopkins Bloomberg School of Public Health. Insurance status appeared to be the biggest predictor of whether a person got oral health care: For those with incomes just over the federal poverty level, 27% of those without dental insurance had a dental visit in the previous year, compared to 65% with dental insurance, according to an analysis of 2012 Medicare data.

Income also played a role: High-income beneficiaries were almost three times as likely to have gotten dental care in the previous 12 months compared to low-income beneficiaries, 74% of whom got no dental care. Many high-income beneficiaries paid a sizable portion of their bills out of pocket – even those with dental insurance. “Medicare is focused specifically on physical health needs and not oral health needs and, as a result, a staggering 49 million Medicare beneficiaries in this country don’t have dental insurance. With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem,” says study author Amber Willink, Ph.D., an assistant scientist in the Department of Health Policy and Management at the Bloomberg School.

Eighty percent of Americans under 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare. The vast majority of Medicare beneficiaries who have dental insurance are those who are still covered by employer-sponsored insurance, either because they are still working or because they are part of an ever-dwindling group of people with very generous retiree medical and dental benefits.

On average, Medicare beneficiaries reported spending $427 on dental care over the previous year, 77% of which was out-of-pocket spending. Seven percent spent more than $1,500. Dental expenses accounted for 14% of Medicare beneficiaries’ out-of-pocket health spending.

Poor dental hygiene not only contributes to gum disease, but also the same bacteria has been linked to pneumonia. It can also contribute to difficulty eating, swallowing, or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn’t have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.

The researchers analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors.

It would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn’t afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate.

A proposal that has been introduced in Congress would embed dental care into Medicare as a core benefit for all of the program’s 56 million beneficiaries. It is not expected to pass before Congress recesses. With a $7 monthly premium and subsidies for low-income people, it would cost $12.8 billion to $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50% of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay. “It’s hard to tell in this current political climate whether this is something that will be addressed by lawmakers, but regardless this is affecting the lives of many older adults,” Willink says. She cautions that if the costs become too high for Medicare beneficiaries, they could lose whatever wealth they have and end up on Medicaid, the insurance for the very poor which the government pays for fully.

Covered California Launches Open Enrollment

Covered Californians kicked off its fourth annual open enrollment last week for 2017. More than 92% of consumers will have three or more health plans to choose from, and none will have fewer than two. For 2017, most consumers will see a lower copay for their primary care visits. Urgent care costs in every plan will be the same as the primary care visit, helping consumers save up to $55 per visit. Consumers in Silver, Gold, and Platinum plans will pay a flat copay for emergency room visits in 2017 without having to satisfy a deductible. Most outpatient services in Silver, Gold and Platinum plans are not subject to a deductible, including primary care visits, specialist visits, lab tests, X-rays and imaging.

Even consumers in Covered California’s most affordable Bronze plans can see their doctor or a specialist three times before the visits are subject to the deductible.

Three of Covered California’s 11 health plans are expanding their coverage areas. Molina Healthcare is moving into Orange County, Kaiser Permanente will be available in Santa Cruz County, and Oscar Health Plan of California will be offering coverage in San Francisco County. The other plans continuing to offer coverage for 2017 are Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Health Net, L.A. Care Health Plan, Sharp Health Plan, Valley Health Plan and Western Health Advantage. Covered California is also adding two new family dental plans, Liberty Dental Plan and California Dental Network. They will join Access Dental Plan, Anthem Blue Cross, Delta Dental of California, Dental Health Services and Premier Access. Liberty Dental Plan will offer coverage in all ZIP codes in 2017, and California Dental Network will offer very competitive rates in the Bay Area, Los Angeles and Orange counties, and in parts of Sacramento, the north Bay Area, the Central Valley, the Inland Empire and San Diego.

An upgraded online shopping tool enables consumers to see 12 plan options on a page and filter their choices by plan, plan type, price, out-of-pocket costs, quality rating and metal tier, among other features. Consumers can also select their preferred plan and the information will be transferred to the application automatically. Another feature is the ability to shop for health or dental insurance and switch between the two offerings. Consumers who want assistance by phone can leave their number for a call back from the Covered California Service Center.

Starting in 2017, Covered California enrollees who don’t have a doctor will be matched to a primary care physician. They can designate a different physician at any time.

The ACA Spurs Growth of Dental Plans

Dental benefit offerings have seen an uptick as the Affordable Care Act (ACA) has become more ingrained in the U.S. health care system, according to an A.M. Best report. Companies that filed an annual health statement with the National Association of Insurance Commissioners increased their dental net premiums written by 77% over the past decade. The largest annual rate of growth came in 2014, when net premiums written increased 14% year-over-year. Similarly, enrollment grew 53% for the same period, with a 19% year-over-year increase in 2014. Despite geographic and provider network challenges, dental business has given health insurers steady net operating gain profitability over the past decade, with a fairly substantial improvement in results since 2009. The consistent operating profitability has been supported by a loss ratio from 60% in 2008 to 64% in 2013. Dental writers benefit from the mostly consistent utilization of policyholders. They usually don’t experience large one-time shock claims that may be associated with more typical health lines of business, which keeps the loss ratio fairly manageable and predictable. As companies expand into individual dental markets where adverse selection is a potential risk, the products are modified to include longer waiting periods for major dental services and lower annual maximums.

The top 10 dental writers account for 62% of the market, with MetLife holding the dominant share at 17%. The individual dental market also is highly concentrated as the top 10 players account for 67% of the market, led by MCNA Insurance Company’s 30%. Individual dental benefits are relatively new, with interest emerging and premium growing rapidly over the past 10 years. Regardless of some provider network challenges and certain under-served geographic areas, the dental insurance industry is poised for growth as employees continue to value the benefit offering and more dental insurers participate in the ACA exchanges. Increasing competition, including numerous small carriers expanding their exchange offerings, may pressure operating results. But underwriting gains in each of the past five years are substantially higher than levels recorded in 2005-2009, according to A.M. Best. To get a copy of the report, visit http://www3.ambest.com/bestweek/purchase.asp?record_code=254956.

Making the Most Out of Open Enrollment


Nearly half of employees are stressed by the open enrollment process and only half are confident about the benefit decisions they made last year, according to a study by MetLife. Millennials are the most stressed and confused. When asked about the most effective benefit resources, respondents ranked one-on-consultations well above other resources. In fact, Millennials led their generational counterparts in valuing one-on-one consultations. However, only half of employers offer one-on-one consultations. Sixty percent of Millenials consult with their families and friends on benefits. MetLife says that employers need to help their employees connect the value of non-medical benefits to their day-to-day lives. Employers should also do the following:

  • Make sure that employees fully understand key terms such as “deductible,” “premium,” “PPO,” and “HMO.”
  • Have employees ask themselves, “Do I have a big life event coming up, such as marriage or retirement?” It’s critical to choose benefits based on present and future needs.
  • Make sure that employees review their benefits and fully understand them. Only half of employees said they thoroughly reviewed their benefits choices last year.

The survey also reveals how employees feel about their benefits:

  • Financial uncertainty: In contrast to decreasing unemployment numbers, American workers remain pessimistic about their financial future. Less than half feel in control of their finances. Even fewer expect their situations to improve in the next year (46% in 2015, compared to 52% in 2014). More than half are concerned about having enough money to cover out-of-pocket medical costs as well as meeting monthly living expenses and financial obligations. These worries that have increased every year since 2012.
  • Job Satisfaction: More than half of employees are satisfied with their jobs and are committed to the organizations’ goals. An increasing number plan to be with their companies a year from now.
  • Financial Benefits: 71% of employees consider work to be the foundation of their financial safety net. Sixty-two percent of employees want more financial security benefits. Millennials are more financially vulnerable compared to their counterparts. Gen Xrs say they are less secure than other generations.
  • Appreciation of benefits: Half of employees agree strongly that their benefits help them worry less about unexpected health and financial issues. Seventy percent of employees say that having customizable benefits would increase their loyalty to their employer.
  • Supplemental benefits: Employees continue to ask for a range of solutions, especially for more common benefits, such as medical, prescription, 401(k), dental, life, and vision care. Employers are keeping pace with many of their employees’ top benefit requests. However, there are large gaps in accident insurance, critical illness, and hospital indemnity. Most employers understand how non-medical benefits can provide financial protection, such as offsetting out-of-pocket medical expenses. Yet, only 47% of employees believe that supplemental health benefits can help close these gaps.
  • A streamlined plan design: Plan design, claims management, and implementation rank highly as advantages of streamlining the number of carriers that employers use.
  • Use of enrollment firms: Three-quarters of employers have positive attitudes towards enrollment firms. Seventy-one percent of employers say that working with an enrollment firm helped them improve benefit communications.
  • Wellness plans: More than two thirds of employees are interested in physical well-being programs that reward healthy behavior. This is especially true among Millennials (75%) and female employees (72%).
  • Retirement Benefits: Forty percent of employees say that having retiree benefits is a key reason to stay with their employer. Millennials feel the most strongly about this, probably due to their lack of financial confidence. About a third of employees plan to postpone retirement, an increase of 5% over 2015. Almost 6 in 10 employees plan to work or consult once retired. Of this 60%, 44% plan to work part-time.
  • Older workers: With today’s workers redefining what it means to be a retiree, employers must also redefine what retiree benefits look like in order to appeal to this rich reservoir of talent. For example, 63% of employees say that dental is a must-have retiree benefit while only 42% of employers offer it. Similar gaps can be found across other critical non-medical benefits, such as vision and life insurance. More than half of employees say that their employer does not offer any employer-paid non-medical benefits. With retiree benefits being such an important loyalty factor for many employees, employers have an opportunity to keep pace in 2016 and beyond.

Last Updated 06/29/2022

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