Medicare Advantage Dental Plans: More Gaps Than Care

Medicare Advantage, the commercialized version of Medicare that provides benefits beyond traditional Medicare, like dental insurance, is becoming increasingly popular. However, a recent analysis shows that the quality of dental coverage provided by Medicare Advantage is below average, with only 8.4 percent of plans providing a dental benefit that satisfies the study's quality requirements(1^✔ ✔Trusted Source
Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County

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First author Lisa Simon, MD, DMD, of Brigham and Women’s Hospital’s Division of General and Internal Medicine, a founding member of the Mass General Brigham healthcare system, stated, “Our study suggests that many Medicare Advantage beneficiaries may not have access to the dental care they need, even if they are enrolled in a plan that nominally provides them with dental coverage."

After analyzing Medicare data from late 2023, Simon and her colleagues created a list of criteria for a comprehensive dental benefit comparable to employer-sponsored plans.

These criteria included providing dental cleanings without a co-pay, having a minimum annual coverage of $1,500, and not requiring an additional premium to access these dental services.

The team’s analysis included 6,333 Medicare Advantage plans with a total enrollment of more than 27 million beneficiaries. The investigators found that 86.6% of plans offered a dental benefit, but only 8.4% offered a comprehensive benefit that met quality standards. Also, 94% of Medicare beneficiaries were enrolled in a plan offering a dental benefit, but only 4.1% were enrolled in a comprehensive dental benefit.

These findings might explain why only about half of Medicare Advantage beneficiaries visit the dentist annually, similar to the rate for beneficiaries in traditional Medicare who lack most dental coverage.

“Many of the attributes we studied—like how much coinsurance a patient would need to pay or whether procedures like fillings or crowns are covered—are fairly complex and probably pretty overwhelming for consumers to review during open enrollment season,” said Simon.

Regulations could prevent low-quality dental plans from being offered in the first place and ensure that consumers know what they’re getting when they pick a Medicare Advantage plan.

Reference:

1. Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County - (https:jamanetwork.com/journals/jama/article-abstract/2828480)

Source-Eurekalert