Title: Financing Mechanisms for the Senior Dental Market Dr. Kathy OLoughlin, Moderator
1Financing Mechanisms for the Senior Dental
MarketDr. Kathy OLoughlin, Moderator
2The 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
3The 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
4National Health Expenditures, 2002
Dental
(CMS, August 2004)
5Dental Services by Source of Payment, 2002
(CMS, August 2004)
6Sources 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
7Government 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
8Massachusetts
- 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
9Health 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