- Associated Press - Thursday, October 29, 2015

BEND, Ore. (AP) - No matter how well people take care of their teeth, things start to fall apart in old age.

Eighty-year-old Betty Williams of Redmond found that out recently when she needed a crown, a bridge and an implant. The dental work set her back about $10,000. Like more than 70 percent of the population age 65 and older, she doesn’t have private dental insurance. Medicare doesn’t cover dental care, nor is it included in the retirement benefits her husband earned as a Washington firefighter.

“It kind of hurts out-of-pocket, it really does,” Williams said.

Williams would have paid even more if she hadn’t joined her dentist’s discount club, which saved her about $3,100. Her dentist, Taylor Fowles at East Bend Dental, began offering memberships in April of 2014 after he bought the practice. Fowles said it’s been a good way to attract new patients. “It just makes sense for people that don’t have insurance,” he said.

Dentists have always had the ability to offer discounts to cash-paying customers, as long as the savings didn’t exceed insurance network discounts. In fact, Williams said she used to get a 5 percent discount from Fowles’ predecessor. But more dentists are marketing membership plans, in which patients pay a set annual or monthly fee, which typically covers preventive care and entitles them to discounts on other work, such as fillings and crowns.

At least three independent practices in Central Oregon offer membership plans, as does Willamette Dental Group, a chain with an office in Bend. The discounts that are offered range from 10 percent to 20 percent.

Access to dental care appears to be increasing because of the Affordable Care Act, according to a just-released study by the American Dental Association’s Health Policy Institute. Dentists point out that about half of Americans still lack private dental insurance. Those who offer memberships say in-house plans, which are not insurance, make care affordable and encourage people to get routine cleanings and check-ups.

“We just want them to do the preventive stuff as much as possible because it saves them so much money in the long run,” Fowles said.

Membership clubs have their advantages, but consumers also have to be aware of the limitations. The most obvious is that the membership and discount is only good at that practice, so if patients move, or switch dentists, they could lose money paid upfront.

The plans are largely unregulated, though the Oregon Insurance Division says it reviews many plans that dentists offer in order to make sure they won’t be confused with insurance. Some dentists might be required to register their plans with the state as discount medical plans, which are similar to memberships but usually involve a third party. Discerning the difference can be difficult.

“It gets complicated really quickly,” Insurance Division spokesman Jake Sunderland said. “The rule of thumb is if they’re charging for the discount, then they most likely need to be licensed.”

Sunderland said consumers should check with the state before joining a plan.

PureCare Dental in Bend was the first practice in Central Oregon to offer a membership plan, starting when the practice opened in 2010. Dentist Eric Cadwell, who ran a medical software company before going to dental school, developed the plan with his brother, who is a dentist in Washington, said Brianna Cadwell, who is married to the dentist and is the business manager. The brothers had seen other practices using them. “This is the direction dentistry is headed because dental insurance just doesn’t make sense anymore,” she said.

Many dental insurance policies have a maximum annual benefit of $1,000, so the monthly premium ends up acting like prepayment toward those benefits, Brianna Cadwell said.

PureCare’s basic membership costs $19.50 per month and includes two cleanings, exams and sets of X-rays per year, plus two emergency office visits, Cadwell said. The discount on further work is 15 percent to 20 percent, depending on the work.

While the membership fee is lower than most dental insurance premiums, the discount on major work is less than what one would receive with insurance.

People who choose to join a dentist’s membership plan instead of buying insurance can maximize their savings by paying the membership fee out of a Health Savings Account. The accounts are available to people who have high-deductible health insurance, and they help save money on medical expenses because deposits into the account aren’t subject to federal income tax.

Sometimes it’s unclear what qualifies as a medical expense that can be paid out of an HSA. Internal Revenue Service spokesman David Tucker said dental membership fees do qualify if they cover services, rather than access to the discount.

If a dentist offers a 15 percent discount to club members on, say, a crown, and that member falls into the 15 percent federal income tax bracket and pays for the work out of an HSA, “You’re doubling your savings, really,” said Kathie Gedde, a partner at SGA Certified Public Accountants and Consultants in Bend.

PureCare has 40 percent of its patients using the membership, Cadwell said. It appeals to senior citizens and the many working adults in Central Oregon who are self-employed or work for small companies that don’t offer dental benefits, she said.

The memberships also benefit dental practices. People who join the club seem to be more diligent about taking advantage of the preventive care, Cadwell said. When patients do need work, they’re less likely to put it off because they’re not subject to annual limits or waiting periods.

“They’re not in this insurance mindset,” she said. “They’re able to dictate their care with their dental team.”

Membership plans are becoming so popular with dentists across the country that Bend resident Dan Marut stopped practicing dentistry in order to focus on his membership business, Quality Dental Plan, which now has 500 clients in 47 states. While some dentists craft their own membership plans, many turn to a company like Marut’s to help them get started and market the plan.

“Most dentists out there are solo or in small groups,” Marut said. “This is unique to our profession. We’re not only the ones performing the dentistry, we’re running the office as well.”

Dentists are more concerned about reaching people who are foregoing care than competing with insurance companies, Marut said.

“That’s our competition. Education,” he said.

People skip needed dentistry more than any other area of health care because of financial barriers, according to an annual survey by the American Dental Association. Financial barriers were more common for dentistry than any other field, which included prescriptions, eyeglasses, mental health and medicine. In 2014, 10 percent of the population did not get dental care they needed because of the cost, according to an ADA analysis of National Health Interview Survey data.

Because of the Affordable Care Act, however, those barriers are dropping across health care, including in dentistry, the ADA’s analysis said.

“The establishment of health insurance marketplaces as well as Medicaid expansion could increase dental benefits coverage and demand for dental care,” the authors concluded.

The ADA also found that in 2013, dental utilization rates were stable among working-age adults for the first time in five years. And dental care for children, who are more likely to be covered by Medicaid, reached its highest utilization rate since 1996. Not all states allow Medicaid to cover dental care, but it is included in Oregon Health Plan benefits.

More Oregonians are also covered by private insurance. Enrollment in dental-only insurance plans has risen from fewer than 700,000 people in 2011 to 1.1 million, according to the Oregon Insurance Division. That data doesn’t include dental care that’s embedded in medical insurance policies.

Coombe and Jones Dentistry in Redmond began offering a membership plan in 2010 because people were losing their jobs and employers were dropping benefits, office manager Kerrianne Bethers said. Coombe and Jones dentists were more interested in offering existing patients a way to keep up with their preventive care than marketing to new patients, Bethers said. The practice has about 200 people, or about 7 percent of its patients, enrolled in the plan, which costs $29.99 per month. (There are various prices of membership, depending on whether one needs more frequent cleanings because of gum disease.) The discount on additional work is 10 percent.

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Information from: The Bulletin, https://www.bendbulletin.com

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