Enrollment trends in employer-sponsored health plans that include dental benefits.

BACKGROUND: In this study, the authors provide a better understanding of enrollment trends associated with dental plans embedded in private-sector, employer-sponsored insurance health plans for the years 2005, 2010, 2015, and 2018. METHODS: Data used were from the insurance component of the Medical Expenditure Panel Survey. The authors present the number of employees enrolled in employer-sponsored insurance health plans and the percentage of these employees enrolled in health plans that include dental benefits. The authors present yearly estimates for 2005, 2010, 2015, and 2018, according to employer characteristics and state. RESULTS: While the number of embedded dental benefit plans has decreased from approximately 14.1 million plans to slightly more than 9.3 million plans in 2018 since 2005, the percentage of enrollees in employer-sponsored insurance health plans with dental coverage has decreased from approximately 23.2% of enrollees to slightly more than 15.0%. CONCLUSIONS: Although the percentage of embedded dental plans is decreasing, they are still an important component of the dental insurance market and are especially important to those employees who are enrolled. PRACTICAL IMPLICATIONS: Information will provide a better understanding of the source and extent of embedded dental plans provided via private-sector employers. These plans are often less generous than stand-alone plans.

Substantial Churn In Health Insurance Offerings By Small Employers, 2014-15.

New data for 2014-15 from the Medical Expenditure Panel Survey-Insurance Component longitudinal survey show substantial churn in insurance offers by small employers (those with fifty or fewer workers), with 14.6 percent of employers that offered insurance in 2014 having dropped it in 2015 and 5.5 percent of those that did not offer it adding coverage.

The effect of dental insurance on dental care use and selection bias.

OBJECTIVES: We examine the effect of dental insurance coverage on the probability of having a dental care visit in light of selection bias. METHODS: We use data from the 2003 Medical Expenditure Panel Survey and use 3 different approaches to control for selection bias. First, we use a probit specification and include a rich set of independent variables that we posit control for unobserved attitudes toward risk and health care. Second, we use an instrumental variable model with family employment status as our instrument. Finally, we use a nonparametric approach to identify the upper and lower bounds of a dental insurance effect. We also ran a base probit model that did not include controls for attitudes toward risk and health care. RESULTS: The base probit, the probit including measure of attitudes, and the instrumental variable models provided similar estimates of the effect of dental insurance on the probability to seek dental care. This may indicate that selection bias may not be a concern. All estimates were within the bounds obtained through the nonparametric approach. CONCLUSIONS: Despite concerns of the potential endogeneity of dental insurance in models that estimate dental care use, we find evidence that these concerns may be unfounded.

Characteristics of employers offering dental coverage in the United States.

BACKGROUND: The authors conducted a study to describe the current market for dental benefit offerings by employers and to describe the number and percentage of establishments that offer dental care coverage. METHODS: The authors examined the 2006 Medical Expenditure Panel Survey-Insurance Component and describe the number and percentage of establishments that offered at least one health insurance plan; establishments that offered dental insurance; and, of those establishments that offered at least one health insurance plan, the percentage that offered a dental insurance plan. RESULTS: The study results show that 56 percent of all establishments offered health insurance in 2006. Approximately 35 percent of all establishments and 63 percent of establishments that offered health insurance offered dental insurance in 2006. CONCLUSIONS: The difference in employee coverage rates between health insurance and dental insurance is reflected largely in the rates at which employers offered health insurance and dental insurance coverage in 2006. PRACTICE IMPLICATIONS: By understanding these analyses, practitioners will be better positioned to provide care, improve access and respond to changes in the health care coverage marketplace.

Parity for whom? Exemptions and the extent of state mental health parity legislation.

Between 1997 and 2003, the share of workers subject to mental health parity laws greatly increased. But because of exemptions for self-insured firms and small firms, coverage is much lower than a simple tally of state mandates would suggest. Limits on the types of conditions covered further weaken these laws. This paper summarizes the extent and scope of state parity legislation in terms of the number of insured private-sector employees covered. It explicitly accounts for the Employee Retirement Income Security Act (ERISA) exemption for self-insured plans, exemptions for small employers, and the range of conditions covered by the law.

A closer look at the managed care backlash.

BACKGROUND: Much anecdotal evidence exists regarding the managed care backlash of the late 1990s, but limited empirical evidence is available. OBJECTIVES: Using a unique series of employer surveys, we examined trends in enrollment rates in health maintenance organizations (HMOs) and other plan types between 1997 and 2003. RESEARCH DESIGN: We present enrollment rates in employer-sponsored health plans by plan type. These plan-level enrollment rates are disaggregated by whether or not enrollees had a choice of plan types and by firm size and year. SUBJECTS: Employees who were enrolled in employer-sponsored health insurance in private sector establishments. RESULTS AND CONCLUSIONS: Although we found evidence of a decline in the popularity of HMOs, it occurred later than indicated in earlier studies. In our data, HMO enrollment rates fell from roughly 32% to 26% between 1997 and 2003, with most of the decline occurring after 2001. Earlier studies reported that the decline in HMO enrollment rates occurred between 1996 and 1998, and between 2000 and 2001. In addition, an interesting story emerged when we examined trends by firm size. We found evidence of a decline in the HMO enrollment rate for large employers starting in 1998. However, this was offset by an increase in the HMO enrollment rate in small employers, which explains the stability in our figures before 2002. Our data also indicated that when workers were given a choice between an HMO and other plan types, workers increasingly opted for the non-HMO plan during this time period.

Workers' decisions to take-up offered health insurance coverage: assessing the importance of out-of-pocket premium costs.

BACKGROUND: Many proposed policy initiatives involve subsidies directed toward encouraging employers to offer coverage and toward workers to encourage enrollment in offered plans. Given that insurance coverage reflects employers' decisions to offer coverage, eligibility requirements for such coverage, and employees' take-up decisions, all three elements are important when considering mechanisms to decrease the number of uninsured individuals. RESEARCH DESIGN: In this study, we examine the relationship between workers' decisions to take-up offers of health insurance and annual out-of-pocket contributions, total premiums, and employer and workforce characteristics. We model the take-up decision using cross-sectional data from approximately 18,000 establishments per year from the 1997 to 1999 Medical Expenditure Panel Survey - Insurance Component. RESULTS: We find that workers are less likely to enroll in coverage as single employee contributions increase. Our results for family contributions are much smaller than for single contributions and are not statistically significant in all years. Our simulation results suggest that reducing employee contribution levels for single coverage from existing levels in 1999 to zero would yield an increase in take-up rates of roughly 6% points in establishments that had required a positive level of contributions. Our results also indicate that of the 13.8 million private sector workers who decline coverage from their employers, 2.5 million would potentially enroll in employer-sponsored coverage if the cost of single coverage were to fall to zero. CONCLUSION: Reducing employee contributions will increase take-up rates; however, even when employees pay nothing for their coverage, some employees elect not to enroll.