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By 2028 the number of individuals aged 65 and over will increase to 68 million from just under 51 million in 2018. Of the current 51 million, only 40% have dental insurance coverage making available to carriers, agents, and FMO’s opportunities for capturing some of the growth within the senior market.

Normally, seniors will acquire dental coverage through either Medicaid or private sources. These private sources are usually provided to a group of retirees or employees and packaged with health coverage options. However, seniors that receive coverage through Medicare lack dental benefits. Dental coverage for seniors has outpaced the growth in the senior population by 5% to 3% respectively.  The 2% discrepancy is generally thought to be due to one-time changes with the Affordable Care Act (ACA), like moratoriums on the “ACA fee,” expansion in dental benefits, and confusion associated with the individual mandate.

When selling dental coverage to seniors, several key factors need consideration.
1. Employer group benefits are plentiful, but individual plans are limited. Of the individual plans available only 40% have policies available to beneficiaries through the age of 65. The plans available to seniors have a higher premium rate for beneficiaries because of an attained age of 50 or 60.

  1. There is also no standardized set of benefits, and coverage is structured as “Preventive,” “Basic,” “Major.” This model is very similar to most employer group plans, and includes things like annual deductibles, waiting periods for significant services, and an annual maximum.
  2. Another key factor in considering plans for beneficiaries is the network. Benefits are usually higher for in-network providers which will drive down a client’s out of pocket cost. As an agent, you should consider the cost of being within a network is worthwhile. Although it is ultimately something that will need in-depth discussion with your clients.
  3. Health Insurance was made more accessible by the ACA, but there are limits for dental coverage. Of the ten essential health benefits, pediatric dental care is mandatory, but there is no requirement for adults. Due to the lack of coverage, some plans provide dental plans for adults through ACA marketplaces.

As the 65 and over crowd retires and will be faced with lacking dental coverage upon retirement, the growth opportunities are apparent. Current dental results have been stable and consistent according to CSG Actuarial, and they see the potential for adding profitable growth. Consider adding dental benefits in conjunction with your MA plans, if you have any questions, please feel free to reach out to Agent Pipeline, Inc. at 800-962-4693.

 

https://storage.googleapis.com/csg-actuarial-wordpress.appspot.com/2018-Senior-Dental-Market-Projection-FINAL.pdf

 

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