Dental Plans For Medicare Patients - Meredith Freed Follow @meredith_freed on Twitter, Nancy Ochieng, Nolan Sroczyński, Anthony Damico and Krutika Amin Follow @KrutikaAmin on Twitter
Dental benefits are generally not covered by Medicare except in limited circumstances, and many people using Medicare do not have any dental coverage. Some Medicare beneficiaries have access to dental coverage from other sources, such as Medicare Advantage plans, but the coverage of dental services, if they are covered, varies widely and is often quite limited, which can result in a high cost price for people with severe . or unaccounted for dental needs.
Dental Plans For Medicare Patients
Policymakers are currently debating how to make dental care more affordable by extending the scope of dental care to people using Medicare. President Biden's budget request for fiscal year 2022 includes "improving access to Medicare dental, hearing and vision care" as part of the president's health care program. Senate Democrats recently announced a deal to expand Medicare, including dental, vision and hearing, as part of a budget reconciliation package, although details of the deal have not yet been released. In 2019, the House of Representatives passed the Elijah E. Cummings Low Drug Costs Now Act (H.R.3), which adds dental benefits to Medicare Part B, along with benefits for vision and hearing, in addition to legislation to reduce the cost of prescriptions. drugs Earlier this year, Representative Doggett, joined by 76 members in the House of Representatives, introduced the Medicare Dental, Vision, and Hearing Benefit Act (HR 4311) to cover these benefits under Medicare Part B.
Medicare Dental Insurance Coverage
In light of the ongoing political discussions, this report provides new data on the percentage of Medicare dental coverage beneficiaries, attendance at the dentist in the last 12 months, and out-of-pocket dental expenses. We will also take a closer look at the range of dental services offered to Medicare Advantage members in individual plans in 2021. We are focusing on Medicare Advantage plans because they have become the primary source of dental coverage among Medicare Advantage recipients. Our analysis is based on multiple datasets, including the Medicare Current Beneficiary Survey for dental appointments and ongoing dental costs, and Medicare Advantage Enrollment and Benefit files for each Medicare Advantage plan. To provide a more detailed picture of dental services, beyond what is available in these datasets, we will analyze the dental coverage offered by the 10 geographically dispersed Medicare Advantage plans offered by various relatively high enrollment insurers offering dental services (see Methodology and Annex ). ). .
Nearly 24 million people, or about half of all Medicare beneficiaries (47%), had no form of dental insurance in 2019 (Figure 1).
Other Medicare beneficiaries have access to dental coverage through Medicare Advantage, Medicaid, and private plans, including employer-sponsored retirement plans and customized plans.
In 2019, 29% of all Medicare beneficiaries had access to certain dental services under Medicare Advantage plans (including 3% of Medicaid-eligible beneficiaries who had access to Medicare Advantage dental coverage). Another 16% had coverage under private plans. About 11% of Medicare beneficiaries had access to Medicaid dental coverage (including those above who also have Medicare Advantage coverage). As Medicare Advantage enrollment increases, an increasing proportion of Medicare beneficiaries have access to some of the dental coverage under the Medicare Advantage plan, so the proportion of all Medicare beneficiaries with some dental coverage would likely be higher in 2021.
Dental Insurance Options For Seniors On Medicare
An earlier analysis of the 2016 Medicare Current Beneficiary Survey (MCBS) and other data sources found that nearly two-thirds of Medicare users (65%) had no dental insurance this year. However, due to a data collection and processing problem that was later identified by the CMS, the private dental insurance estimates obtained by MCBS were lower than they should have been by an unknown scale. CMS resolved this issue in 2017. Because of this and other methodological changes in our analysis, as explained in the methodology, estimates of the number of people using Medicare with dental insurance cannot be trended using our 2016 estimate.
Lack of dental care can worsen chronic conditions such as diabetes and cardiovascular disease, delay diagnosis of serious conditions, and lead to avoidable complications that sometimes lead to expensive emergency room visits.1 Medicare beneficiaries opt out of routine and other dental procedures.
In 2018, half of Medicare beneficiaries did not visit the dentist (47%) – with even higher rates among blacks or Hispanics (68% and 61%, respectively) (Figure 2).
When analyzing race and gender, we found that a greater proportion of black and Hispanic women (64% and 59%, respectively) had not visited the dentist in the last year than white women (40%). The same pattern is found among men: a greater proportion of black (74%) and Hispanic (64%) men than white (44%) have missed a dental appointment.
Options For Containing The Cost Of A New Medicare Dental, Hearing, And Vision Benefit
Low-income beneficiaries report having a dental appointment in the previous year much less often than high-income beneficiaries. Nearly three-quarters (73%) of Medicare beneficiaries with incomes below $10,000 per year did not visit the dentist, compared to 25% of beneficiaries with incomes above $40,000.
Health status was also correlated with dental care. Almost two-thirds (63%) of all beneficiaries with good or poor self-rated health had a dental appointment in the last year, compared to 41% of beneficiaries with excellent, very good or good health.
These relatively low tooth wear rates are not related to the decline in use caused by the COVID-19 pandemic, as they are based on data from 2018, the last available year that was before the pandemic.
Most of the beneficiaries who used dental services in 2018 (88%) paid for their care out of pocket. Among all beneficiaries, the average out-of-pocket dental expense was $454 in 2018, although this includes a large number of beneficiaries who did not have any dental care this year. Among about half of all Medicare beneficiaries who received some dental service, the average out-of-pocket expense for dental care was $874 in 2018. One in five beneficiaries who used dental services spent more than $1,000 out-of-pocket on dental care , including one in ten who spent more than $2,000 (Figure 3).
If Congress Adds Dental Coverage To Medicare, Should All Seniors Get It?
Medicare Advantage plans may provide additional ("supplemental") benefits that are not covered by traditional Medicare Medicare, such as dental, vision, hearing and fitness services. You can cover the cost of these benefits with rebate dollars. Plans may also charge additional premiums for these benefits. In 2021, 94% of people enrolled in Medicare Advantage with individual plans have access to some dental coverage. The majority (86%) of Medicare Advantage participants had access to a plan with broader coverage, while 14% had access to only preventive coverage. Preventative dental coverage under Medicare Advantage plans typically covers oral exams, cleanings, x-rays of the teeth and sometimes fluoride treatment. More comprehensive services include a number of services, including restorative services (e.g. fillings), endodontics (e.g. root canal treatment), periodontics (e.g. scaling and root smoothing), prosthetics (e.g. dentures, dental implants) and oral surgery.
Almost all Medicare Advantage members who have plans that offer access to dental services (including if they have to pay a premium for these services) have access to preventive care services, including oral exams (100%), cleanings (100%), and X-rays (99%), although fewer registered have access to fluoride treatment (59%).
Service Limits. Medicare Advantage plans usually limit the frequency with which you get certain covered services within specific time frames. For example, almost all enrollments (88%) have plans that have frequency limits on the number of cleanings, with the most common limit being twice a year. For other services, such as x-rays, the frequency limits vary more from one plan to another. For example, 36% of those enrolled have plans that limit the number of x-rays to a specific time frame, with the most common limit being once a year.
Insured services (except preventive). Among those enrolled in plans that offer access to more comprehensive services, the type of coverage varies by plan: 96% of enrollees have plans that offer reconditioning services such as fillers; 83% have mining plans; 76% have plans that include periodontics and/or prosthetics; 64% have plans that include endodontics, such as root canal treatment; and 60% have plans that include diagnostic and/or non-routine services. However, we did not explore the frequency limits for more comprehensive services because these service categories cover a variety of treatments and it is not always clear what an individual plan covers in each of these service categories.
Does Medicare Cover Dental?
Under the prosthetic services category, some beneficiaries may have access to prosthetics insurance, which is a frequently needed service among seniors. As of 2018, nearly 14% of people aged 65 and over have edentulism, which means they have no natural teeth. We couldn't determine the details of dental coverage from an analysis of national data, so we looked at ten illustrative plans in more detail. Five of the ten plans specify that they include dentures (partial and full), and each plan limits the prostheses to 1 set every 5 years (Appendix Table 1). Among those five
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