Individual insurance plans rarely include dental

Dec 23, 2007

Acupuncture? Yeah! Chiropractic? Yes, please. But dentistry? Nah. Those are the results of a recent survey by America's Health Insurance Plans (AHIP) that asked its member insurance companies what kind of benefits they are giving customers with individual plans.

Individual insurance policies are those that consumers buy for themselves or their families without assistance from an employer, the government, or any other organization. Some plans offer dental benefits, some don't, and some offer dental as an option at added cost.

AHIP simply reported the percentages of customers who had dental benefits, without counting how many had been offered the benefit but turned it down. For its survey, AHIP collected data on 2.9 million individual policies, covering about 4.2 million people.

The survey divided the insurance plans into four categories. First came preferred provider organization (PPO) and point-of-service (POS). In these plans, customers have incentives to get healthcare from within a network of providers, but can get some coverage from providers outside the network. Only 14% of the consumers who bought this type insurance for themselves had dental benefits. When they bought insurance for their whole family, the percentage with dental dropped to 8.5.

The next category was health savings account (HSA) and medical savings account (MSA) plans. In these plans (which can also be PPO or POS), individuals make tax-deductible contributions to a savings account from which they can pay for health insurance. To qualify, the insurance plan must have a high-deductible. In this category, only 6.2% of single plans and 4% of family plans included dental.

Health maintenance organizations (HMO) and exclusive provider organizations (EPO) only pay for care given by providers within the network. Only 5.9% of the people in these plans who got individual insurance, and 2.7% who got family plans had dental coverage.

Finally, indemnity plans are the least restricted -- the insurance company pays a standard amount based on the procedure you get, regardless of who does the procedure. In this category, 11.4% of those who bought plans for themselves and 17.5% of those who got plans for their families had dental benefits.

By contrast, alternative medicine options such as acupuncture and chiropractic were much more commonly part of the package. For example, 92.9% of people with single PPO plans had alternative medical coverage.