A Survey of Dental Care Programs Offered by “Qualified” Hmos

None of the federally qualified HMOs had a fully prepaid comprehensive dental care program. Less than a third of the plans went beyond the then mandated benefits of the Act, and those that did, only provided the benefits on a fee-for-service basis. The more established plans, with enrollments exceeding 15,000 members, offered a full spectrum of services, and have acceptable levels of utilization. There appears to be a relation between size and services offered and overall utilization of the dental services. The general direction HMOs are taking with regard to the scope of services provided is hard to predict because more than two thirds of the HMOs studied were "transitional" HMOs. The more mature plans appeared to be leaning toward fully comprehensive services; however, only the "basic" dental services then mandated by the Act were covered by prepayment. It is difficult to predict how the nearly 200 HMOs now being planned and developed will integrate dental care into their programs, especially when dental care services are no longer required as a "basic health service". Based upon the cautious approaches used by the HMOs now in operation, it appears safe to assume that comprehensive dental care programs will not be offered by HMOs until they are forced to do so by competing health insurance carriers or a dental program provides them with a competitive edge

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