Financing Mechanisms for the Senior Dental Market Dr. Kathy O’Loughlin, Moderator

2 The Panel Lowell Daun, DDS – Senior Vice President, Delta Dental of California –Government/Non-Group Market John Baackes – CEO, Senior Whole Health –Dual Eligible Market John Brouder – Partner, Boston Benefit Partners –Commercial Market

3 The Market Seniors = 76 million Baby Boomers Affluent –Independent –Higher level of education –Healthy –Higher utilization of services –With financial resources Middle Class –Culturally diverse –Independent, healthy, limited resources, price sensitive Poor –Frail –Lower utilization of services –Dependent –Poor health/Complex health issues –No financial resources

4 National Health Expenditures, 2002 (CMS, August 2004) Dental

5 Dental Services by Source of Payment, 2002 (CMS, August 2004) < < <

6 Sources of Financing Self Pay – Out of Pocket Social Security –Medicare –Medicaid Health Insurance Corporations –Employer-based –Group or Non-Group –Voluntary or Contributions Discount Plans/Cards Dental Annuity/Health Savings Accounts

7 Government Financing Mechanisms Federal Employees Retiree Programs Retired Military Medicare –Medically necessary dental care only –<1% of Medicare tax dollars –Part D for dental care/pharmacy Medicaid –Title XIX of Social Security Act –Varies from state to state –Poor elderly only

8 Massachusetts M.G.L. Chapter 58 The Connector Authority Commonwealth Care and Commonwealth Choice 600,000 Adults have dental and vision benefits 50,000 newly eligible have dental benefits Employers: provide coverage for 550,000 uninsured over next three years

9 Health Care Reform Dental is an inseparable part of health and overall wellness – 89% of consumers surveyed agree on medical/dental connection Dental is different: 3 rd party carriers add value with negotiated fee arrangements Dental coverage creates affordable access for millions of Americans – 164 million Large untapped market: Nearly half of population lacks a dental benefit