Dental Plans—A Little Long In the Tooth

In the 1950s, life may have been simpler—but dental care certainly wasn’t. Some people saw it as a luxury that they couldn’t afford. Most people suffered from tooth decay, and dentures became common. Then employers started to offer a new benefit, the dental insurance plan, to help employees take care of their teeth.

Five decades have come and gone, and dentistry has evolved. The impact on the average American mouth has been huge, with lower rates of tooth loss. Interestingly, the evolution seems to have bypassed the average American dental plan. Dr. Alan Vogel, national dental director for MetLife, would like to see that change.

Dental plans, he says, should be based on three things: research, market demand, and cost. By considering all three, Vogel says, the typical dental plan could save money and provide a better product for patients.

Applying accepted research would result in big changes in typical dental plans, says Vogel. For example, plans generally pay for bite-wing X-rays twice a year. In the 1950s when the plans began, that may have been necessary. However, the American Dental Association now bases its recommendation for X-ray frequency on the patient’s individual situation.

“They say that once a year is fine, or even less often for people who are healthy and stable. If they’re not, then the X-rays should be taken more often. When you start building that kind of research into the plan, you start reducing the costs on services that add no value,” says Vogel.

Crown restorations are another example of a big expense with little justification. Plans often pay for crown restoration every 5 years. But, says Vogel, a properly constructed and placed crown typically lasts 10 or 15 years. “Why would a dentist replace a crown if it doesn’t need to be replaced? In many cases, you’ll find that cosmetics drive the decision. The crown is perfectly healthy, not causing any problems, but the person wants to lighten up their teeth a little more. If you move the frequency for crown replacements from 5 years to 7 or 10 years, you can save a lot of money.”

On the other hand, dental plans typically don’t pay for tooth implants, something that patients highly value. Savings gained by changing the frequency of X-rays or crown replacements could be applied to implants, higher plan limits, or other services valued by patients. “Most people say they would rather have implants covered at no additional cost than have the plan pay for a crown replacement after 5 years when it doesn’t even need replacing,” Vogel says. “When you follow those three ideals—research, market demand and cost—you create a plan that adds greater value to the employee, with lower costs. That’s Nirvana, isn’t it?”