A comparison of potential treatment costs for group capitation versus voluntary individual enrollment plans

As competition among insurance companies for increased market share intensifies, dental plans designed for new markets have begun to appear. One such plan is marketed to individuals not eligible for group plans. The purpose of this study was to determine if differences in potential treatment costs exist between patients enrolling in individual-targeted plans and those in group-based plans. The cost of treatment plans to eliminate dental disease and replace missing teeth whenever possible and/or practical was calculated for 119 patient pairs from both types of plans. Individually targeted patients had significantly higher levels of potential treatment costs, which were due primarily to significantly greater needs for operative, periodontal surgery, and endodontic services. These findings are important to insurance companies in designing plans that are both equitable and attractive to consumers and potential providers of care, who must weigh their costs of providing care against anticipated revenues.