How will the ban on denials for pre-existing conditions work?

This is the first mention I’ve seen of the plan covering dental care. Is this true? (Not that I’d mind if it did - I have access to dental coverage though work, I just haven’t taken it the past few years because I haven’t needed anything but routine cleanings in 15+ years, and the plan they offered was so expensive and covered so little and had such a low maximum annual benefit that it didn’t make any sense for me to take it, because even if something sudden and horrible happened to my normally boring teeth, anything the insurance would have covered would be something I could pay out of my own pocket.)

What do you mean by “the plan”? There’s no government plan, just a set of laws governing how private health insurers can do business.

If something sudden and truly horrible happened to your teeth there’s a good chance it would be covered by your medical policy. Unless we have radically different ideas of what sudden and horrible means.

The health care reform plan. I am speaking globally.

That’s why I haven’t bothered with the dental plan currently available to me; I haven’t needed anything other than a cleaning in 15+ years, and on the off chance I needed something covered by my dental plan rather than my medical plan (which covers traumatic injury to natural teeth, which is the only thing that is remotely likely to happen anytime soon, as I had my wisdom teeth out years ago), so little would be covered because of the maximum annual benefit that it’s simply not worth it for me to pay the premiums; I’m glad to take the (relatively small) risk of paying out-of-pocket for cleanings, and take the chance on needing to pay out of pocket for a filling or extraction or something.

What I am wondering is if the requirement for everyone to have insurance also extends to dental insurance.

Although there’s a lot I hate about the new law, I kind of hope this part is true, because then we can gloat back at the Canadians! (or at least the Ontario-ians, whose government doesn’t provide dental for adults.)

Hey! What’s up with medicine requirements in the new law? That’s another thing we might be able to be Ontario at. Again, for them it’s out of pocket, or private insurance, too.

I’m not sure what you mean by ‘the plan’, because as Fuzzy Dunlop pointed out, there is no single plan offered by the health reform bill. The system will broadly stay as it is now: insurance plans will be drawn up by insurance companies, and it’s still up to them what they include and what they don’t.

However, there will be a new set of federal minimum requirements that all plans have to include, and if you’re asking whether these minimum requirements will include dental care, I have to admit I’m not sure. I suspect they don’t. But millions of currently-uninsured people will now be required to buy insurance, and more than half them will get generous federal subsidies towards whatever plan they buy, so my guess is a fair number of them will buy plans that include dental care. Plus a lot of people who are currently on high-deductible plans because they can’t afford comprehensive coverage will probably find that, with subsidies, comprehensive plans that include dental coverage are suddenly much more affordable, and they’ll switch. This medical journal seems to think that Obama’s plan will greatly expand the number of people with dental insurance.

Are you basing this on anything in particular? I’ve never heard of a single “health insurance plan” that included dental care - I’ve always had the opportunity to sign up for dental coverage through work, but it was always a completely separate plan from medical insurance, and always offered through a different provider than the medical insurance. I’ve honestly never heard of such an animal.

(Although frankly, especially given the monuting evidence that dental health and overall physical health are linked, I think having plans that covering everything would be a good idea. I remember back in the day, when my HMO doc told me I had mitral valve prolapse and should take antibiotics before dental cleanings, my dentist was happy to write me a prescription for them - but then the HMO prescription coverage refused to pay for it because it was written by a DDS rather than an MD, even though it was for a non-dental reason. It was like $5 anyway, so I just paid out of pocket, but still, I thought it was pretty stupid.)

Dental plans are either purchased independently from companies offering dental plans or as riders on medical insurance plans. There’s not a big difference either way as an employee. Often they’re offered through a different insurer, like Delta Dental, but they can be from the same insurer as your medical too.

For instance, a few years ago my health insurer offered dental plans from Delta, until they launched their own line of dental plans and that was the only option if you wanted it included on your health policy as a rider. We’re a very small group and nobody liked the participating dentists with the new dental plan so we dropped the dental rider and bought a separate group policy from another dental insurer.

Minor math quibble: the premiums will add up to whatever treatment costs plus 25%, because 20% is one quarter of 80%. E.g., for treatment costs of $100, they would charge $125, because $100 is 80% of $125.

For that person. Premiums can be raised in general, so long as 80% of them goes to care. Unless there is a rate freeze in there that the opposition unaccountably didn’t scream about.

This is not even remotely true. The average net profit margin (net profit divided by revenue) for the healthcare insurance industry is around 4.4%. For 2009, here were the net profit margins for some of the bigger insurance companies.

United: 4.39%
Aetna: 3.67%
Cigna: 7.07%
Humana: 3.36%

When they say that 80% of premiums (majority of revenues) must go toward medical care, that doesn’t mean that the remaining 20% is simply profit. There are all sorts of additional expenses that a company would have such as overhead, debt service costs, and income taxes.

And salaries. Including executive salaries. (Unless you’re including that under “overhead” already.)

That 80% figure is for group insurance only. Insurers have to spend at least 85% for their individual business as a whole, calculated separately from the 80%. The jargon term for these figures is the “loss ratio” or “medical cost ratio”.

Also, I believe that 80%/85% also includes medical management programs, such as disease management, care management, etc. The remaining 20%/15% is really only for sales, general, and admin expenses (SG&A); profit; tax; etc. Speaking as an industry insider, these mandated loss ratios would have been extremely unrealistic and fought tooth and nail by the insurers otherwise if medical management costs were not included in the calculation.

As an aside, most industry execs don’t consider the loss ratio to be a very useful metric of an insurance plans efficiency. This is unfortunate, because it is the single most important number that investors look at when assessing a company’s financials.

Apologies, I meant that at present most insurers take more than 20% of premium revenue for non-medical costs, which from next year will be illegal. The overall point was valid though: if insurers are forced to spend 80% of their premium revenue on medical care or rebate the rest back to customers, that should exert a downward pressure on premiums as they stand today.

I thought that dental plans which operate as ‘riders’ on top of general health insurance plans were usually offered by the same insurance company, and would be eligible for subsidies. I could be wrong about that. (I know the House bill originally included dental and vision coverage as part of the costs of an employer-provided health insurance plan for the purposes of the Cadillac tax, although the Senate bill and the final bill ultimately did not). Either way, the International Medical Travel Journal, which I linked to above here, thinks that Obama’s plan will expand dental coverage to millions more people.

This is not necessarily the case. If the 80% figure was stringent enough to force the insurance company to abandon medical management programs, that would obviously reduce the administration costs. However, this could result in a less healthy and therefore more expensive population, raising medical costs higher than the reduction in administration costs achieved by the abandonment of these programs. So, even though the company might now be spending north of 80% on medical costs, total costs would be higher than in the absence of such a requirement, resulting in higher premiums (and a less healthy population to boot).

B doesn’t necessarily follow from A in this case however, and if the loss ratio requirements have the intended effect of reducing wasteful administration costs without the abandonment of management programs, then it would indeed result in a downward pressure on premiums. This also depends on whether or not management programs are included in the 80% figure as I mentioned above.

I buy my own insurance and dental is included in it. If this is about employer provided dental, when I had it, it was included. Only eye care was separate (but sometimes still provided, just through a different company).

This is where I’m at in my thinking, now. It seems like the best strategy is to just carry insurance for catastrophic events, and wait to get real insurance afterward if you need to. This is such an obvious strategy that I really hope somebody thought of it before we did.

There will be a set of minimum requirements for insurance plans, and strict limits on deductibles and co-payments, so I suspect that will effectively make “cheap, emergency-only” insurance plans illegal. However, the strategy you suggest is still one that makes sense for a lot of people: you’ll have to pay at least a $695 fine for not having insurance, but beyond that there’s not much in the bill to stop you doing it. The CBO predicted that something like 5 or so million people will do this. If more than that start doing it, the system could start getting into real trouble and Congress would probably end up raising the fine.

I’m just waiting for the government to require auto insurers to accept pre-existing conditions. There’s this tasty little Scout II I have my eye on that needs quite a bit of body work.

Nicely put.

I notice there is (not) surprisingly no replies to my question about what happens if someone chooses to pay fines instead of getting insurance and comes down with flesh-eating bacteria, stage 3 melenoma or tertiary syphilis.