The world of dental care is at a critical crossroads. With outdated payment systems, inefficient benefits structures, and rising out-of-pocket costs, oral health remains overlooked in the broader healthcare ecosystem. Yet, the economic burden of oral disease is undeniable—$144 billion lost annually in productivity, coupled with four times the out-of-pocket spending compared to medical care.
At Toothsome, we’re building a solution that combines direct contracting with modernized payment structures, leveraging limited-purpose ICHRAs (Individual Coverage Health Reimbursement Arrangements) to align incentives and unlock greater access to care. By doing so, we’re pioneering a new category in oral health benefits: Direct Dentistry.
The numbers are clear: oral disease in the U.S. has an outsized impact on both individuals and employers.
What’s driving these inefficiencies? At the core, legacy insurance systems that were designed decades ago fail to meet the needs of today’s patients, providers, or employers.
Unlike medical insurance, dental insurance has always operated as a prepaid benefit, not true insurance.
Here’s the key difference: medical insurance is built on a risk pool model, where low utilizers subsidize high utilizers to cover catastrophic costs. But in dentistry, the $1,500 annual cap means there’s no safety net for high utilizers—patients needing crowns, root canals, or dental implants are left with overwhelming out-of-pocket costs.
For employers, this creates an inefficient system where they pay premiums for a benefit that’s poorly utilized and ill-equipped to address major dental needs. Meanwhile, providers face declining reimbursements and administrative headaches that reduce their ability to focus on patient care.
This mismatch of incentives has created a fragmented system, ripe for innovation. The solution? Direct Dentistry.
Direct Dentistry is a modern approach to delivering and paying for dental care. It eliminates insurance middlemen by enabling direct contracting between employers and top-tier dental providers, ensuring:
1️⃣ Transparent pricing: Patients know exactly what their care will cost upfront, without hidden fees or confusing coverage rules.
2️⃣ Higher provider reimbursements: Dentists receive fair compensation without the administrative burden of dealing with insurance companies.
3️⃣ Employer-driven solutions: Employers can offer tax-advantaged dental benefits via a limited-purpose ICHRA, allocating funds that go directly toward care instead of unused premiums.
Toothsome’s Center of Excellence (COE) Platform takes this one step further by curating a network of the top 10% of dental providers nationwide, ensuring patients receive high-quality care and predictable outcomes.
While traditional ICHRAs (introduced in 2020) allow employers to reimburse employees for qualified medical expenses, a dedicated dental ICHRA offers several key advantages:
This model empowers employers to address a specific, high-impact area of employee health while driving ROI through reduced absenteeism and improved productivity.
Dental implants are the perfect entry point for direct contracting. Why?
1️⃣ High Demand: 52% of Americans experience tooth loss, yet only 6% can afford implants due to cost barriers.
2️⃣ High Impact: Implants not only restore function and aesthetics but also prevent future complications like bone loss and adjacent tooth decay.
3️⃣ High ROI: Employers offering dental implant benefits see measurable returns through improved employee health and satisfaction.
By starting with dental implants, Toothsome can address a pressing need while laying the foundation for a broader Direct Dentistry Ecosystem.
Imagine a world where dental benefits are:
This is the vision behind Toothsome. By combining direct contracting with modern payment tools like limited-purpose ICHRAs, we’re not just reimagining dental insurance—we’re replacing it.
Oral health is health. It’s time to stop treating dentistry as an afterthought and start investing in innovative solutions that drive better outcomes for patients, providers, and employers alike.
The era of Direct Dentistry is here—and Toothsome is leading the charge.
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