Expenditure patterns during twenty-five years of dental benefit plan coverage

In 1980 a municipality in western New York adopted a dental plan for current and former employees. The plan design has remained constant since then: Class I – 100% UCR, Class II – 85% UCR, Class III – 60% UCR. There is no Deductible, nor is there coverage for Orthodontics. The initial individual Annual Maximum of $750 was increased to $1,000 after several years. This study examined annual benefits paid for individuals who received dental services in each of six years: 1985, 1990, 1995, 2000, 2005, and 2010. The number of patients ranged from 6,312 in 1985 to 9,755 in 2010. Patients were divided into ten cohorts: ages 5<20, 20<35, 35<50, 50<65, and 65+; and by gender. In every cohort mean annual benefits increased, but the point-to-point rates of increase varied – from approximately 6% compounded annually for the youngest cohorts to approximately 3% for the oldest. Within each cohort 80th percentile of benefits paid during a year was considerably higher than 50th percentile amounts, often more than double. In all cohorts the top twenty percent of patients accounted for approximately one-half of aggregate benefits paid for that cohort. Over time the fraction of benefits accounted for by the top twenty percent decreased, for every age grouping and for both genders. Median, mean, and 80th percentile benefit payments were surprisingly uniform between genders and within age cohorts over the twenty-five year period. With appropriate data, dental benefits costs, and associated dental workforce requirements, can be predicted and budgeted with confidence.