1. Health Policy Institute Taking Stock of the Pediatric Dental Benefit “Mandate” Under the ACA Thank you for joining! You will be on hold until the call begins at 11 a.m. Central time Please remember to mute your phone unless you are speaking This webinar will be recorded If you are not currently connected by phone, dial 1.866.740.1260 If prompted, enter meeting number: 4407745

2. © 2014 American Dental Association. All Rights Reserved. 2 Today CHAIR Marko Vujicic, PhD, Chief Economist & Vice President, HPI PRESENTER Cassandra Yarbrough, MPP, Health Policy Researcher, HPI COMMENTATORS Colin Reusch, MPA, Senior Policy Analyst, Children’s Dental Health Project Taylor Priestley, MPH, MSW, Certification Program Manager, Covered California Evelyn Ireland, CAE, Executive Director, National Association of Dental Plans

3. © 2014 American Dental Association. All Rights Reserved. 3 Why We Did this Study We want to estimate out of pocket spending under alternative marketplace plans for children (FFM). To do this, we first need to understand dental care utilization and spending patterns.

4. © 2014 American Dental Association. All Rights Reserved. 4 Methods Data sources: –Truven Health MarketScan® Research Databases 2,055,356 children included in our sample –FAIR Health Dental Benchmark Module (for “market” fees) –ADA Survey of Dental Fees (for orthodontia “market” fees) We analyze utilization rates by procedure for every dental procedure. We estimate dental spending using two different assumptions for fees: –“Market” fees (what dentists submit as charges) From FAIR Health (and ADA Survey of Dental Fees for orthodontia services) –Actual fees paid (what dentists are paid) From Truven Health MarketScan® Research Databases We group children into three age groups and four spending quartiles. This generates 12 distinct “patient profiles.”

5. © 2014 American Dental Association. All Rights Reserved. 5 Percentage of Children with Private Dental Benefits and No Dental Spending, by Age Group Source: ADA HPI analysis of 2013 Truven data.

6. © 2014 American Dental Association. All Rights Reserved. 6 Utilization Rate for the Top 25 Most Common Procedures Ages 1 through 18Ages 1 through 6Ages 7 through 12Ages 13 through 18 D01200.950D11200.854D11201.264D01200.952 D11200.764D01200.677D01201.137D11100.804 D12080.568D12080.485D12080.759D12080.454 D11100.332D02720.251D02720.527D02740.373 D02720.307D12060.185D13510.526D86700.315 D13510.306D01500.185D12060.229D11200.281 D02740.196D02200.150D02200.200D13510.246 D86700.185D02300.138D02300.170D02720.151 D12060.182D13510.089D86700.161D23910.150 D02200.167D23920.079D71400.160D02300.148 D02300.153D21500.075D23920.120D02200.148 D01500.123D92300.054D02740.115D12060.139 D23920.108D02400.051D21500.110D23920.116 D23910.103D29300.046D01500.109D72400.111 D71400.085D12030.046D03300.098D03300.100 D21500.084D23910.043D23910.090D01500.098 D03300.082D01400.039D12030.086D21400.096 D21400.071D21400.038D92300.075D21500.068 D12030.057D71400.034D21400.066D01400.062 D01400.055D01450.032D01400.057D80800.056 D92300.048D32200.030D80600.046D71400.052 D72400.046D03300.028D80800.031D02100.040 D80800.034D23300.019D02100.031D12030.039 D02100.030D02740.016D71110.024D72300.036 D02400.021D13300.012D29300.022D92200.036

7. © 2014 American Dental Association. All Rights Reserved. 7 Estimated Average Annual Dental Spending, Valued at “Market” Fees (per FAIR Health), by Category of Dental Service, Age Group and Dental Spending Quartile in 2015 Dollars Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All” includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for spending quartiles excludes individuals with no dental spending.

8. © 2014 American Dental Association. All Rights Reserved. 8 Estimated Average Annual Dental Spending, Valued at Actual Fees Paid (per Truven), by Age Group and Dental Spending Quartile in 2015 Dollars Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All” includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for spending quartiles excludes individuals with no dental spending.

9. © 2014 American Dental Association. All Rights Reserved. 9 Estimated Average Annual Dental Spending, Valued at Actual Fees Paid (per Truven), Patient Payments vs. Insurer Payments Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All” includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for spending quartiles excludes individuals with no dental spending.

10. © 2014 American Dental Association. All Rights Reserved. 10 Estimated Average Annual Dental Spending, Valued at “Market” Fees, Actual Fees Paid, and Consumer Payments, by Age Group and Dental Spending Quartile in 2015 Dollars Source: ADA HPI analysis of 2013 Truven claims data, 2012 and 2013 FAIR Health procedure charges. Notes: Analysis for “All” includes all children with private dental benefits regardless of dental spending (i.e. includes children with no spending). Analysis for spending quartiles excludes individuals with no dental spending.

11. © 2014 American Dental Association. All Rights Reserved. 11 Key Messages More than 1 in 4 children with private dental benefits do not use their benefits. Fees paid to dentists through private dental benefits are significantly lower than market fees. This leads to substantial differences in total dental spending estimates based on “market” versus “actual” fees. Most children spend more out of pocket on premiums, copayments and coinsurance than the actual “market” value of their dental care.

12. Colin Reusch Senior Policy Analyst, Children’s Dental Health Project

13. Taylor Priestley Certification Program Manager, Plan Management Division, Covered California

14. Evelyn Ireland Executive Director, National Association of Dental Plans

15. © 2014 American Dental Association. All Rights Reserved. 15 Thank You! For more information on the Health Policy Institute please visit: ada.org/hpi To inquire about speaking engagements or custom data analytics please contact: hpi@ada.org