Dental Insurance Inequality Worsens as Orthodontic Costs Rise
Inequalities in access to orthodontic care are growing, particularly impacting patients receiving increased intervention support, according to a recent study. A new dental agreement for 2026-2027, while aiming to address costs, may inadvertently exacerbate these disparities, critics say.
New Dental Agreement and Rising Tariffs
The 2026-2027 dento-mutual agreement introduces “maximum tariffs” for dental practitioners in response to a planned ban on supplementary fees for patients with increased intervention support (BIM) starting July 1. Yet, Solidaris, a socialist mutual insurer, argues that these tariffs could allow providers to charge higher fees to patients with standard coverage, effectively increasing overall costs. Source
The study by Solidaris found that in 50% of cases, the new tariffs match or exceed current supplementary fees. This raises concerns that orthodontic treatment will develop into more expensive, limiting access for financially vulnerable groups.
Financial Burden on Vulnerable Patients
Even with reimbursements from complementary and voluntary dental insurance, BIM patients currently pay an average of €1,094.75 out of pocket for standard orthodontic treatment. Solidaris estimates that a €18 million budget could have halved these costs for BIM patients, and urges authorities to allocate funds to improve reimbursement rates. Source
Trends in Orthodontic Treatment
Data from Wallonia indicates a steady increase in orthodontic treatment among children, rising from 26% in 2014 to 31.19% in 2024. Despite this increase, significant disparities persist. 33.93% of children with standard coverage (BO) receive treatment, compared to only 26.57% of BIM-affiliated children. Source
Call for Tariff Inclusion in Maximum Billable Expenses
Solidaris is advocating for the inclusion of these “maximum tariffs” within the cap on maximum billable expenses (MAF) to prevent further cost increases and ensure equitable access to orthodontic care. Source
Dental Insurance Contract Considerations
When considering a dental insurance contract, it’s crucial to thoroughly read, understand, and evaluate the terms to determine if it’s a sound business decision. The American Dental Association (ADA) offers a free Contract Analysis Service for its members to assist with this process. Source
Key Contract Issues to Consider:
- Hold Harmless Clause: These clauses can shift liability to the dentist for losses incurred by the insurance company, even in situations where the company shares some fault.
- Contract Negotiation: Dentists can negotiate terms with insurance providers individually, particularly regarding reimbursement rates.
- Terminating Agreements: Carefully consider the implications before terminating a network agreement with a dental plan.
Exploring Dental Insurance Options
Individuals and families seeking dental insurance can explore various options offered by companies like Physicians Mutual, which provides coverage for dental, life, health, and Medicare needs. Source