Introduction:

Dr. Reyes stood over her front office manager’s desk, squinting at the monthly production report. New patient flow was stable, hygiene reappointment rates were strong—yet collections were slipping. “Why are so many of our patients delaying care?” she asked aloud. The answer wasn’t simple. But recent studies suggest a shifting landscape in dental insurance utilization—one that every dentist needs to understand.

If you’ve noticed inconsistencies in patient compliance, preventive visit frequency, or a rising dependence on insurance benefits, you’re not alone. Here’s what the most recent research (2023–2025) tells us about how patients are using their dental benefits—and how it might affect your practice.

Key Findings From Recent Studies

1. Utilization Is Normalizing After COVID-19 Volatility

The National Association of Dental Plans (NADP) reported in early 2024 that dental benefit utilization has largely returned to pre-pandemic patterns. This “re-stabilization” is promising, especially as it reflects patients' growing comfort with returning to regular preventive and elective care.

• Takeaway for Dentists: Schedule hygiene patients further in advance, and consider reactivating unscheduled treatment from 2020–2022 that was postponed.

Source: NADP Report on Dental Utilization Trends

2. Preventive Services on the Rise, Major Treatments Flat or Down

A 2023 Milliman study examined data from over 1 million Medicare Advantage dental beneficiaries. It found a 7.2% increase in preventive services, while usage of major restorative treatments declined slightly by 2.9%.

• Interpretation: More patients are prioritizing cleanings and checkups but deferring crowns, implants, or bridges—often due to cost-sharing concerns or annual maximum limits.

• What You Can Do: Educate patients early on the importance of completing diagnosed major work before benefits reset, and provide in-office financing options to soften out-of-pocket burdens.

Source: Milliman Medicare Advantage Dental Utilization Study

3. Fully-Insured Enrollment Is Growing

From 2019 to 2023, Mark Farrah Associates found that the number of Americans enrolled in fully-insured dental plans grew by 9 million, totaling 97.6 million covered lives. Despite economic uncertainty, demand for dental insurance remains high—particularly through employer-sponsored plans.

• Implication: You may see more patients with coverage, but also more constraints tied to PPO fee schedules, downgrades, and claim limitations.

• Actionable Tip: Monitor which plans are becoming more dominant in your area. Focus on negotiating better fees with them or consider strategic moves out-of-network when PPO fees don’t support quality care.

Source: Mark Farrah Dental Enrollment Report

4. Medicaid Dental Enrollment Fluctuates

With the expiration of the COVID-19 public health emergency, many states began redetermining Medicaid eligibility. Sun Life, the parent company of DentaQuest, reported a temporary drop in Medicaid dental enrollments. However, they expect recovery by 2025 as new enrollees stabilize.

• Your Role: If you serve Medicaid patients, prepare for fluctuating appointment volumes, especially among pediatric patients. Create flexible scheduling models and consider outreach for patients who’ve lost coverage but may qualify again soon.

Source: Reuters – Sun Life Medicaid Enrollment Trends

Cost and Premium Trends

• Premiums Remain Stable: NADP reports that dental insurance premiums increased by less than 1% in 2023, even as inflation rose in other sectors.

• Future Cost Projections: Segal’s 2025 Health Plan Cost Trend Survey anticipates a 4.5% increase in costs for dental provider organizations over the next year—meaning practices will face higher overhead even if insurance reimbursements remain flat.

Sources: NADP Statistical Report and Segal Health Plan Survey*

Global Market Expansion

If you’re planning to expand or diversify your services (e.g., teledentistry, AI-enhanced diagnostics, or membership plans), you’re on trend. Precedence Research projects the global dental insurance market will grow from $247.96 billion in 2025 to over $540 billion by 2034, with technological integration playing a large role.

Source: Precedence Research – Global Dental Insurance Market Forecast

What This Means for Your Practice

• Prevention is King: Patients are more likely to use preventive benefits. Maximize this trend by scheduling ahead, bundling preventive with minor restorative care, and promoting your hygiene department.

• Major Treatment Hesitation: Economic pressure is causing patients to delay major treatment. Offer payment options, clear value explanations, and pre-deductible strategies to boost acceptance.

• Insurance Complexity Isn’t Going Away: PPO participation, plan shifts, downgrades, and coordination of benefits are still major roadblocks. Invest in training your front office and treatment coordinators to navigate benefits efficiently and accurately.

Final Thought

Dr. Reyes, like so many of us, was once overwhelmed by the unpredictability of insurance-driven care. But when she leaned into the trends, empowered her team, and made financial conversations clearer for patients, things changed. Production stabilized. Patients followed through with treatment. And dentistry felt less like a fight—and more like the mission it was meant to be.

Stay informed. Stay adaptable. And remember: You’re not alone in this ever-shifting landscape.

Need Help Negotiating PPO Fees or Streamlining Insurance Processes?
Check out www.VeritasDentalResources.com to gain control of your profitability.

Benjamin Tuinei

Founder - Veritas Dental Resources, LLC
Phone: 888-808-4513

Services:
PPO Fee Negotiators | PPO Fee Negotiating | Insurance Fee Negotiating
Insurance Credentialing | Insurance Verifications

Websites:
www.VeritasDentalResources.com | www.VerusDental.com