Oral health is associated with your overall health and wellness. According to WebMD, a leading source for trustworthy health and medical news, your oral health may be an early indicator of more serious underlying problems. Oral issues have shown links between heart disease, diabetes, eating disorders, rheumatoid arthritis, certain cancers, immune system disorders, and other illnesses. With COVID-19 and the variety of added stress on the American population at this point, dentists are increasingly seeing more dental issues. My dentist was recently commenting on how many people need mouthguards now, who had never experienced grinding or clenching issues before. Additionally, they are seeing more cracked and chipped teeth, as well as cavities and crowns because of the poorer overall health in the pandemic, as well as a greater increase of stress.
Even in the best of times, without a pandemic, your clients’ dental health should be a priority. For those reasons, you, as an advisor, should make it a significant step in your process to offer dental insurance along with all other medical insurance.
Not surprisingly, dental insurance has become a popular option for companies that offer group health benefits. An impressive two-thirds of the 164.2 million Americans have dental coverage. According to the National Association of Dental Plans, roughly 90% of dental coverage is offered through an employer or other group programs.
The benefits of proper oral care are hard to argue, yet dental insurance is one of the most overlooked insurance plans by advisors. Advisors are so focused on the initial reason for the interview, perhaps for individual medical or Medicare, and the advisor forgets to cover dental options. I am guilty of this myself, as are many of the people I work with. Do not make the same error. You need to remember to offer dental.
There is only a 50% chance that the client you are meeting with already has dental coverage. You may be overlooking a sales opportunity. The potential clients we are working with likely have a group health insurance plan, which typically offer dental insurance. They are meeting with you, a trusted advisor, and requesting help for their overall health insurance needs. Dental is a big part of that picture. Ask the simple questions because your clients need your advice. Incorporate the dental inquiry into your process. “Do you currently have dental insurance? Would you like for me to include dental insurance quotes?” Easy, right? The worst they can say is no. I guarantee you are losing more by not asking. This is such a simple step to integrate into your practice. Ask the question early in your process when you are doing your intake interview with a new client. If you incorporate this into your routine, you will be one step ahead of other advisors.
Be prepared to answer the common questions.
How much does dental insurance cost?
Dental plans can vary quite a bit in cost. The costs mainly revolve around the benefit amount and covered services. Compare a dental plan with $800.00 per year benefits that do not cover major services (like crowns or implants) to a $3,000 per year plan with a benefit covering crowns and implants. Plans that cover orthodontia, cost even more. Consider a PPO versus an HMO dental plan, as that will drive the rates. HMOs tend to have smaller networks and require referrals. Whereas, a PPO usually has a much wider network and allows more flexibility in seeing out-of-network dentists.
Some plans are shelf-rated, meaning that they charge based on the plan covering the individual policyholder, one dependent and policyholder, or two or more dependents. Other dental plans are rated individually based on age or age bands. For example, a 5-year rate band example is buying the policy at 65, and your rate increases when you reach the age of 70.
Currently, the average cost of a $1,500 PPO dental plan, in Texas, ranges from $35-$50 per month for a single individual. Rates are based on the area you live in, so this estimate can vary depending on the state and zip code.
My dentist does not accept insurance. How would the claim be handled? Can I still use this plan?
This is a great question because most people have had their dentist for a long time or found a dentist they love, and they do not want to change. We all know change can be hard. They have a dentist they trust, so they do not want to look for another dental provider. If they have a PPO plan or a plan that allows for out of network coverage, they can still use that dentist.
There are steps for the client to take and you can help to explain the steps, so they understand. Overall, they will always get the most bang for their buck with an in-network dentist.
When using an out-of-network dentist it is up to the individual dental office how (or if) they will file the claim. Some dentists will work with the insurance company and file the claim even if they are not in-network. When this happens, they will usually require some form of upfront payment at checkout. After the dental office has filed the claim and receive payment from the insurance company, then they will apply the upfront payment made and send the client a bill for the balance. This is the simplest scenario when out of network.
What if the dentist does not want to file the claim with the insurance company?
In this situation, the client will check out and pay the total amount due for the services rendered. Then, the client will submit the needed information to the carrier for reimbursement. The important thing here is knowing what is required by the insurance company. The client needs to know the exact process for reimbursement/coverage of claims for out-of-network dentists. This can be a challenging step in their claim process since the dental office did not handle the insurance processing for them. You will want to know the instructions for each carrier as this question comes up from the client. Helping them through this will be a huge benefit to the client and your relationship with them. Just be sure to have some simple instructions for them if they are committed to staying with their dentist who may be out of network.
Is this a real insurance plan?
This may sound like an odd question to you, but it is a very valid concern. Usually (pre-COVID) when I would go into a dental or doctor’s office, I would always look around at the different pamphlets and brochures to pass the time. A few years ago, I was in a dental office and saw a trifold brochure of what looked to be a dental insurance plan. As I was looking over the pamphlet it was noticeably clear to me it was not insurance. It was a discount program. The back of the brochure had some rates that were much higher than dental insurance plans at that time. A discount plan is just that, a discount. Usually, you pay a monthly membership fee to receive a pre-negotiated rate for services performed. When you check out, you pay the discounted rate and go on your merry way. The prices vary widely on discount plans. Do not be fooled because discount plans are not dental insurance. I am not claiming to be an expert on discount plans. The difference between dental insurance and discount plans is that there is no cost share (or benefit amount) included in a discount plan. When you buy a dental insurance plan, you purchase the benefit amount that the company pays towards claims. An example would be $2,000. The $2,000 is your annual benefit pool that the company uses to pay towards claims at the pre-negotiated rate. Therefore, it makes perfect sense that someone would ask if you are showing them a real insurance plan.
Offering dental insurance is a good idea.
These are some of the most frequently asked questions I hear on the topic of dental insurance. Knowing the answers to FAQ’s is important when offering dental insurance to your clients. This can be an overwhelming topic for a client if no one helps them through the process.
Additionally, it is likely that no one is talking to them about this much needed coverage if you, as their health insurance agent, are not bringing it up. Dental is a great added offer to any potential sale and can bring case value to your client, and thus, your relationship with them. Remember, you cannot sell something if your client does not know that you offer it.
Where can I find the experts on Dental Insurance?
There is good news! EMG Insurance Brokerage is a full-service brokerage company based in Houston, Texas. Since 1987, we have been independent insurance professionals in all 50 states. We know dental insurance. I hope that the information provided brings awareness to the solutions available. Utilize your new knowledge and begin to incorporate dental inquiries into your process. Please reach out to EMG Insurance Brokerage today for guidance. We are here for you.
Director of Health
Elite Insurance Brokerage