Financing Mechanisms for the Senior Dental Market Dr. Kathy OLoughlin, Moderator

1
Financing Mechanisms for the Senior Dental
MarketDr. Kathy OLoughlin, Moderator
2
The Panel

• Lowell Daun, DDS Senior Vice President, Delta
  Dental of California
• Government/Non-Group Market
• John Baackes CEO, Senior Whole Health
• Dual Eligible Market
• John Brouder Partner, Boston Benefit Partners
• Commercial Market

3
The Market

• Seniors 76 million Baby Boomers
• Affluent
• Independent
• Higher level of education
• Healthy
• Higher utilization of services
• With financial resources
• Middle Class
• Culturally diverse
• Independent, healthy, limited resources, price
  sensitive
• Poor
• Frail
• Lower utilization of services
• Dependent
• Poor health/Complex health issues
• No financial resources

4
National Health Expenditures, 2002
Dental
(CMS, August 2004)
5
Dental Services by Source of Payment, 2002
(CMS, August 2004)
6
Sources of Financing

• Self Pay Out of Pocket
• Social Security
• Medicare
• Medicaid
• Health Insurance Corporations
• Employer-based
• Group or Non-Group
• Voluntary or Contributions
• Discount Plans/Cards
• Dental Annuity/Health Savings Accounts

7
Government Financing Mechanisms

• Federal Employees Retiree Programs
• Retired Military
• Medicare
• Medically necessary dental care only
• Part D for dental care/pharmacy
• Medicaid
• Title XIX of Social Security Act
• Varies from state to state
• Poor elderly only

8
Massachusetts

• M.G.L. Chapter 58
• The Connector Authority
• Commonwealth Care and Commonwealth Choice
• 600,000 Adults have dental and vision benefits
• 50,000 newly eligible have dental benefits
• Employers provide coverage for 550,000 uninsured
  over next three years

9
Health Care Reform

• Dental is an inseparable part of health and
  overall wellness 89 of consumers surveyed
  agree on medical/dental connection
• Dental is different 3rd party carriers add value
  with negotiated fee arrangements
• Dental coverage creates affordable access for
  millions of Americans 164 million
• Large untapped market Nearly half of population
  lacks a dental benefit