BALLOT QUESTION 2 – PART 1

As a general rule, the team at my office is discouraged from using the word “insurance”, because dental insurance is not really insurance. They are dental benefits. True insurance covers loss and damage.

I offer medical insurance to my team as all small businesses do in Massachusetts. A family plan in my office costs $2600 per month. A single person is $900 per month. That includes a $2000 deductible per person as well. Said a different way, $33,200 or $12,800 respectively, is paid out by the patient before the insurance company pays towards anything. When I was growing up, this was called catastrophic insurance; you weren’t covered for the minor stuff, but if you needed anything else, there was insurance coverage.

Dental “insurance” on the other hand, is the complete opposite. Dental benefit plans are meant to cover (or at least partially cover) the minor stuff, but there are no benefits for significant need. In my experience, for an individual looking to get dental benefits on their own, it costs around $700 per year. That gets you an average of $1000-1500 of coverage for the year. THAT is not insurance. Dental benefits are meant to cover the basics of dental care, not the catastrophic issues. That’s the difference between medical insurance and dental benefits.

You may ask, how do insurance companies make any money on this model? They accomplish this in two main ways. The first is that they rely on a significant number of patients not using their benefits. The last statistic I have seen shows that about 50% of the population, regardless of whether they have dental benefits or not, do not visit a dentist at least once per year.
The other way insurance companies make money is to deny or not cover many services. While it may make sense that there is no coverage for services that are purely cosmetic, it makes absolutely zero sense that preventative services such as nightguards or occlusal orthotics (that a significant number of patients really need to control and prevent many issues), are rarely covered. These companies look for every way possible to not pay or delay payment. Ballot Question 2 is asking, Is the percentage of what the insurance company is taking in vs. what they pay out towards patient care, in the best interest of patient care? I’ll come back to that.

All dental offices hear the same things from patients with “insurance” such as, “Is that covered by my insurance?” or “I haven’t been to the dentist in X years because I haven’t had insurance.” Some may say, “Well, dentistry is expensive.” Dentistry can be costly if extensive dental work is needed. For that same $700 per year for individual insurance, you could skip the dental plan and spend 100% of your dollars to see ANY dentist you want twice per year to have your teeth cleaned, x-rayed, and an exam to check for decay, gum disease, joint health and cancer. While this is not what Question 2 is about, it is something to keep in mind. Preventative dental care (excellent home care and routine professional care) is the key to helping prevent the need for more expensive, extensive dentistry.

The way the system is set up now really hasn’t changed since the early 1970’s. That same $1000-1500 benefit existed then, meanwhile everything else has gone way up.

I will continue this column next week to discuss how a YES vote on Ballot Question 2 has the potential to initiate a disruption in the dental insurance industry, in the best interest of patient care. While it isn’t a total solution to the poor system in place, it will hold insurance companies much more accountable for where premium money is spent.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com