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Dental actuarial issues are unique and require specialized knowledge, differing significantly from other lines of insurance, such as medical, disability, and supplemental health. Milliman has consultants who are recognized experts in the dental insurance market. We handle all dental markets, including commercial large and small group, individual, Affordable Care Act essential health benefits, Medicaid, and Medicare Advantage. We work with insurance companies of all sizes, governments, employer groups, provider groups, industry associations, health policy organizations, and startups to provide a range of dental consulting services.
Milliman’s team of experts support premium rate development for a wide variety of clients and products, including commercial large and small group, individual, Affordable Care Act (ACA) compliant essential health benefits, Medicaid, and Medicare Advantage plans. Milliman curates and maintains vast databases that enable consultants to price new products and estimate the cost impact of benefit mandates, regulatory changes, and other external forces. Our consultants have experience in creating and certifying premium rate filings in all states and have a deep understanding of the unique regulatory and competitive landscape of each market.
Our consultants have extensive experience helping clients launch new products and enter new markets. We offer support related to dental insurance product design, ranging from defining covered services to designing cost- sharing structures and utilization controls to meet financial and strategic goals. We have assisted insurance carriers with the design of new products and the adaptation of existing product lines to new markets. We have decades of pricing and product development experience, supported by healthcare data, independent research, and proprietary tools.
Our consultants have broad reserving experience specifically for dental products. We regularly assist clients with their reserving needs, including incurred but not reported reserve calculations, premium deficiency reserves and other reserve calculations, formal statements of actuarial opinion, and other appointed actuary support. Milliman also offers the Claim Reserve Estimation Workbook (CREW), a flexible Microsoft Excel-based model to estimate incurred but not reported (IBNR) liabilities. CREW’s primary asset is its ability to accommodate unusual claim payment patterns, as well as changing enrollments, benefits, unit costs, and other key factors like changes in capitation and provider contracts.
Our experts assist employer clients with managing their dental benefit, including private employers, public employers, and multi-employer pools. We offer comprehensive dental request for proposal (RFP) support services, including drafting RFP questionnaires, administering the RFP, evaluating bidder responses, conducting repricing analyses, and providing insights to assist in final vendor selection. We regularly assist plan sponsors with self-insured benefits to balance offering valuable benefits to employees while meeting financial goals, via plan design support, experience monitoring and benchmarking, annual budgeting and premium equivalent development, and periodic capital needs and reserve analyses.
Our consultants routinely assist clients with dental provider network development and management, providing insight through analytic and strategic support. We have completed analyses to assess the breadth and depth of networks and produce benchmarks for discounts and provider reimbursement levels. We have assisted new insurance carriers with building a provider network and helped established carriers strategically expand existing provider networks. We have experience with developing provider fee strategies to expand access to care while controlling costs and meeting financial goals.
Milliman offers a comprehensive annual PPO network study for dental insurers. The analysis uses claims data provided by study participants and develops competitive market insights into PPO network discounts and network size for participants in the study. The results from the analysis are used to provide strategic insight into both a dental insurer’s own provider networks and the provider network landscape. Through this analysis, insurers are better able to understand their competitive network position and to address areas in which they want to compete or perform better.
This article outlines the dental market landscape for Medicare Advantage plans in 2020 and explores trends that have emerged since 2018.
This paper uses calendar year 2018 Medicare Advantage administrative claim data for enrollees aged 65 and older enrolled in plans with embedded dental coverage to determine the types of dental services used and the dental per…
This article explores the potential effects of the COVID-19 pandemic on the dental industry, considering changes in utilization of dental services that could result from the pandemic and its containment efforts as well as the…
The Federally Facilitated Marketplace (FFM) was created for use by states that elected against the creation of a State-based Marketplace under the Affordable Care Act. Using publicly available data for the 2020 plan year,…
This paper outlines the options for Medicaid dental delivery systems, their current usage, and considerations for each option. It also presents statistics related to the most recent child dental quality scores and discusses…
Milliman released the inaugural Dental Survey in December 2019. The survey represents 50 carriers and $31.5 billion of inforce premium. The survey focuses on commercial dental products and gathered information on top-line…
This paper explores the relationships among a state’s adult Medicaid…
Actuarially sound rating manuals are essential to adequate and competitive…
As innovations in teledentistry continue to emerge, payers, providers, public…
This article uses publicly available data from CMS to explore the current state…
As changes to the Patient Protection and Affordable Care Act or elimination of…
In October 2017, the Department of Health and Human Services published the draft…
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Milliman, Inc., a premier global consulting and actuarial firm, today announced…
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