We have all been affected by the inflationary pressures in the marketplace — whether it’s the higher food prices, gasoline prices, or travel to vacation destinations. This inflationary pressure is also resulting in higher medical costs for those benefits covered by the ARTA Benefit Plans — especially Dental Care.
The dental landscape across Canada varies significantly when it comes to dental fees. Each province publishes a dental fee guide that provides recommended fees for various dental procedures and services. Dental insurance companies and benefit plan sponsors often use that guide as a benchmark for determining reimbursement levels for dental care. Outside of Alberta, virtually all dentists charge according to the rates contained in their respective provincial fee guides. Currently in Alberta, approximately half of general dentists charge according to the current Alberta Dental Association (ADA) dental fee guide. This means that Alberta dentists charge varying prices for dental services, with the vast majority of the remainder charging higher rates than those published in the fee guide.
Earlier this year, the Alberta Dental Association — the organization responsible for publishing the Alberta Dental Fee Guides — announced they were increasing their fees by 6% for 2023. This announcement follows an increase of 4.6% increase for 2022, for a double-digit increase over two years. Even with the increases ARTA made to Dental Care rates effective November 1, 2022, the plan is still spending more on claims than it is bringing in via premiums.
The dental fee guide increase for 2023 and the fact that only about half of the dentists base their charges on the fees published in the ADA’s Alberta Dental Fee Guides means that while ARTA’s benefit plans will pick up most of the costs for your dental care work, you could be paying higher out-of-pocket expenses compared to the dental fee guide’s suggested rates.
However, there are ways to help alleviate these costs:
- Ask your dentist if they charge according to the ADA’s Alberta Dental Fee Guides. If they answer yes, then you could find yourself paying less out-of-pocket as the fees in that guide are, on average, lower. ARTA’s benefit plans use the current provincial fee guide as the basis for payment when calculating how much of a dental procedure fee is going to be paid, meaning that if your dentist also uses the current dental fee guide to determine their charges, the amount you pay out-of-pocket should be relatively easy to calculate.
- You may also ask your dentist to submit a predetermination cost on your behalf to ARTA’s claims adjudicator. This process will inform you about how much of the overall cost is going to be covered by ARTA’s benefit plans and how much you will have to pay out-of-pocket.
- If you can do so (without geographic constraints), you may want to “shop around” for dentists until you find one who does charge according to the current dental fee guide.
The inflationary pressures occurring in the marketplace are also putting upward pressure on the ARTA Benefit Plans’ Extended Health Care claims but not to the same extent as the Dental Care claims. Nevertheless, ARTA is monitoring the experience to ensure we do our best to minimize members’ out‑of‑pocket costs when it comes to receiving the dental services they need.