The Impact of the Biden Administration’s HHS Notice of Benefit and Payment Parameters for 2025:

Dr. Nathan Suter, DDS and Chief Innovation Officer at Enable Dental provides a comprehensive overview of the evolving landscape in dental healthcare, highlighting several key areas based on a proposed change by HHS regarding dental insurance and coverage. 

• Regulatory and Market Adjustments: The inclusion of adult dental services as Essential Health Benefits (EHBs) necessitates Dental Service Organizations (DSOs) to adapt to new insurance coverage standards and reimbursement models. This change demands strategic alterations in service offerings, billing practices, and mastering diverse insurance requirements.

• Integration with Medical Plans: The potential merging of dental and medical insurance suggests a more holistic approach to healthcare. DSOs must prepare to integrate into broader healthcare networks, align their services with medical care providers, and adapt to combined insurance policies.

• Expanded Access to Dental Care: The proposed changes can significantly increase the demand for dental care, especially among adults who previously lacked adequate dental insurance. This could lead to an expansion in services and infrastructure for DSOs to accommodate the growing patient base.

• Increased Dental Insurance Coverage: With more people having dental insurance, there’s likely to be a surge in routine dental check-ups and treatments. This shift can result in a generally healthier population with a greater emphasis on preventive dental care.

• Shift in Patient Demographics: The accessibility of dental insurance is expected to alter the patient demographic, attracting groups that might have previously avoided dental care due to financial constraints.

• Alternative to Employer Plans: As dental benefits become integrated into medical plans on exchanges, employers might opt out of offering separate dental insurance. This could reduce costs for employers while offering employees more comprehensive healthcare coverage, although patients often dislike changes in their insurance carrier.

• Market Shift for Dental Practices: The trend towards insurance plans available through exchanges may require dental practices and DSOs to adapt to a market with more clients insured through these exchanges. This shift could also influence marketing strategies and patient engagement.

• Enable Dental’s Proactive Approach: Enable Dental is already navigating this transformation, focusing on making their services valuable to patients and their medical health plans. The diminishing influence of employers on healthcare policy signals a significant industry shift over the next decade.

At Enable Dental we have already started down this path of making our services valuable to patients and their medical health plans. With the employer having less of an influence on healthcare policy we will see a very big shift in our industry over the next decade.

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