Characteristics of the Covered Group

A second factor affecting the cost of the dental plan is the characteristics of the covered group. Important considerations include, but are not limited to, the following:

• Age.
• Gender.
• Location.
• Income level of the participants.
• Occupation.

The increased incidence of high-cost dental procedures at older ages generally makes coverage of older groups more expensive. Average charges usually increase from about age 30. As one ages, the need for more expensive restorative services increases for those who need dental care.

Gender is another consideration. Women tend to have higher utilization rates than men. For a given age, costs among females are 10–15 percent higher than the costs among males. One study showed that women average 1.9 visits to dentists per year, compared with 1.7 for men. These differences may be attributable to a heightened sensitivity to personal appearance by women rather than to a higher need.

Charge levels, practice patterns, and the availability of dentists vary considerably by locale. Charge levels within the United States range anywhere from 75 percent to 135 percent of the national average, except for Alaska, California, and certain metropolitan areas. Differences exist in the frequency of use for certain procedures as well. There is evidence, for example, that more expensive procedures are performed relatively more often in Los Angeles than, say, in Philadelphia.

Another consideration is income. One study shows that dental care expenditures per participant were 5 percent to 30 percent higher for members of families with higher incomes. Generally, the higher the income, the greater the difference.

Essentially four reasons may account for income being a key factor. First, the higher the income level, the greater the likelihood the individual already has an established program of dental hygiene. Second, in many areas there is greater accessibility to dental care in high-income neighborhoods. Third, a greater tendency exists on the part of higher-income individuals to elect higher-cost procedures. Last, high-income people tend to use more expensive dentists.

Another important consideration is the occupation of the covered group. While difficult to explain, evidence suggests considerable variation between plans covering blue-collar workers and plans covering salaried or mixed groups. One possible explanation is differences in awareness and income levels. One insurer estimates that blue-collar employees are 15 percent to 25 percent less expensive to insure than white-collar employees.