The Dental Drilldown: Dental Membership Plans 101

THE CURRENT RELATIONSHIP between dental insurance companies and doctors and patients is not an equitable one. For example, research shows that, based on the market value of services rendered, doctors are routinely underreimbursed while patients overpay.1 In fact, in 2014 the California Dental Association filed a class-action lawsuit against Delta Dental, claiming that Delta Dental had violated a “duty of good faith and fair dealing” when it tried to lower the reimbursement rates by 8% to 12%.

According to the National Association of Dental Plans (NADP), about two-thirds of the US population receives dental coverage through commercial insurance.3 So it’s understandable why many doctors might feel trapped or pressured into accepting it, even with all the issues. A 2017 NADP report revealed about 77% of Americans had dental benefits in 2016,4 but a research study by the Health Policy Institute concluded that “a significant amount of adult beneficiaries—more than one out of three—do not use any of their dental benefits within the year.”

So what gives? Perhaps it’s because private insurance providers almost seem to discourage use of the coverage, especially considering the amount of red tape they throw in the way: high deductibles, preexisting conditions, spend caps, and premiums, just to name a few. It shouldn’t be a surprise that both doctors and patients have looked for alternatives to sidestep the insurance companies. That’s where dental membership plans come in.