These Retiree Dental Plan FAQs have been shared with us from the Division of Retirement and Benefits. Your concerns and questions can be shared with NEA-ALASKA/Retired by commenting on this article.
Q. How has the retiree dental plan changed?
A. The Division of Retirement and Benefits has procured Moda Health/Delta Dental of Alaska to administer retiree dental plan claims, as well as to provide a dental provider network. Delta Dental is the largest dental network in the country, with over 145,000 dentists in network.
Q. Why do we need a provider network?
A. Provider networks are now very common in the United States, and can be effective in helping to control cost growth.
The premiums for the retiree dental plan increased an average of 7% per year from 2010 to 2013. That was about two and a half times the rate of inflation in Anchorage during the same time period.
For retirees electing “retiree+spouse” coverage, the premiums have increased by $312/year since 2010 (from $1356/year to $1668/year). If this rate of premium growth continued until 2020, the premiums would increase to $2700/year, an increase of $1344/year over the 2010 premium.
Moda Health/Delta Dental of Alaska will help control this cost growth and maintain the financial integrity of the plan—this will help the plan and retirees save money.
Q. How does Moda Health/Delta Dental of Alaska help us save money?
A. Moda contracts with dentists in Alaska to take part in the Delta Dental of Alaska network. 302 dentists in Alaska are now part of this network. That’s about 60 percent of the dentists in Alaska.
A dentist in the Delta Dental network agrees to two important things:
(1) To not charge more than the 80th percentile of charges for a particular procedure.
(2) To not balance bill the member.
Prior to Moda, the recognized charge for a procedure was computed off the 90th percentile of charges for the procedure, and any dentist could balance bill our members.
Here is an example that illustrates the change. Last year a dentist charged $300 to fill a cavity. Assume the 90th percentile of charges for a filling was $250. The plan would pay the dentist 80% of $250, or $200. The member paid the remaining 20% — $50, plus the dentist sent the member a balance bill for $50. Member total charges: $100. Retiree Dental Plan FAQs
Same example under Moda with an in-network dentist. Assume the 80th percentile of charges for a filling is $200. With Moda, the plan will pay the dentist 80% of $200, or $160. The member pays the remaining 20% — $40, and no balance bill. Member total charges: $40.
Q. But my dentist is not in the Moda/Delta network.
A. You can continue to see your dentist, but it may cost you more, particularly if your dentist charges above the 80th percentile. You can call Moda and request an out-of-network cost estimate.
Q. How much more will it cost me?
A. The Delta network has different recognized charge formulas in each state. In Alaska, the Delta out-of-network recognized charge formula is 75% of the 80th percentile. In the example given above, the recognized charge is 75% of $200, or $150, so the plan would pay the out-of-network dentist 80% of $150, or $120. The member pays the remaining 20% — $30, plus the dentist may send a balance bill for $150. Member total charges: $180.
Q. I want to keep my dentist, but I don’t want to pay more for a filling.
A. You have a number of options:
(1) Ask your dentist to join the Delta network.
(2) Ask your dentist to waive the balance bill. In the example above, if your dentist waives the balance bill, your cost goes down by $10.
(3) Show your dentist what you would save if you went with a network dentist. Remind the dentist you are a retiree living on a fixed income.
Q. How has the plan changed with respect to cleanings?
A. Beginning January 1, 2014, the plan provides for cleaning frequency limits. After discussion with retirees in January, we increased the cleaning frequency limits in some cases. The frequency limits are as follows:
one cleaning every six months for most people
up to three cleanings per year for pregnancy
up to four cleanings per year for diabetes or periodontal disease
additional cleanings are available when dentally or medically necessary with Moda/Delta Dental of Alaska approval.
Q. Why have cleaning frequencies?
A. Most people only need one cleaning every six months. Some members were getting 5-9 cleanings per year. That may be dentally necessary in some cases, but if not necessary, these extra cleanings are imposing unnecessary costs on the plan that our members pay for.