Net dental enrollment in dental HMO and PPO plans decreased more than 25% to about 2 million members in year through July.
Delta Dental of California and Ameritas Group Dental were the main contributors to the decline.
Aside from those two, dental insurers said the sector remains largely untouched by proposals to repeal and replace the Affordable Care Act. To start with, the policy includes few mentions in regard to dentistry. The biggest change is its designation of pediatric dental care as an essential health benefit—meaning dental coverage for children must be made available, including small and individual group plans and stand-alone plans.
The 13 dental insurers on the Business Journal’s list are measured by the size of Orange County membership.
• No. 3, Anthem Blue Cross, declined to submit enrollment numbers.
• Delta Dental ranked No. 1 with 844,242 members, a nearly 44% decline. A company spokesperson didn’t respond to a request for comment, but news reports have shown that the dental insurer has been unsuccessful in cost-saving initiatives.
In May, San Francisco Superior Court ruled in favor of the California Dental Association in its lawsuit against Delta Dental, ruling in favor of the association and awarding it $65 million. The group filed the legal action in 2013 in response to the insurer’s plans to reduce reimbursement rates for its Premier plan in the range of 8% to 12%—lower payments to providers. The association said the move was a breach of contract and that Delta Dental hadn’t adequately disclosed its plans to reduce reimbursement rates.
Dentists in Washington and Massachusetts also delivered last year petitions to their respective Delta Dental organizations, alleging interference with the dentist/patient relationship by making dentists accept a low-cost plan. The new PPO plan would reduce reimbursement about 25% to 30%, according to news reports from American Dental Association.
Delta Dental is among the country’s largest dental insurance companies.
• The list’s second and third spots remained unchanged. No. 2, MetLife Inc., has 248,805 local members, and No. 3, Anthem Blue Cross, an estimated 200,000. Nos. 4 through 8 also stayed the same, No. 4, Cigna, growing local membership 2.5% to 174,729, and No.7, Guardian Life Insurance Co. of America, increasing nearly 6% to 121,378.
• UnitedHealthCare Dental ranks fifth, Aetna Dental sixth.
• Ameritas Group Dental switched places with United Concordia Dental, taking ninth place. The latter dropped one place to 10th with 26,003 members, declining 36% year-over-year.
• Nos. 11 through 13 are consistent with last year’s ranking, starting with Smile Brands Inc. and followed by Premier Access Insurance Co. and Dental Health Services.
Smile Brands kicked off the year with an announcement that it’s going digital, incorporating digital scanning technology to enable all-digital workflows to improve patient experience and practice efficiency. It started testing the program last year in several affiliated practices.
Last month, the company entered into a new market, Nevada, via a new partnership with P3 Dental Group based in Las Vegas.
