Dental Coverage For Seniors On Medicare - Follow Meredith Freed @meredith_freed on Twitter Follow Nancy Ochieng, Nolan Sroczynski, Anthony Damiko and Krutika Amin on Twitter @KrutikaAmin
Dental benefits are generally not covered by Medicare except in limited circumstances, and many people do not have dental coverage. Some Medicare beneficiaries have access to dental coverage from other sources, such as Medicare Advantage plans, but the scope of dental benefits, when covered, varies widely and is often quite limited, which can lead to high costs among them. with serious dental needs or unmet needs.
Dental Coverage For Seniors On Medicare
Policymakers are now considering options to make dental care more affordable for people on Medicare by expanding dental coverage. President Biden's 2022 budget request as part of the president's health care agenda includes "improving access to Medicare dental, hearing and vision coverage." Senate Democrats recently announced an agreement to include Medicare expansions, including dental, vision and hearing, as part of a budget reconciliation package, though details of the deal have not yet been released. In 2019, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R.3), which adds dental benefits to Medicare Part B, along with vision and hearing benefits, in addition to provisions that lower drug costs. . Earlier this year, Representative Doggett, along with 76 members of the House of Representatives, introduced the Medicare Hearing, Vision, and Hearing Benefits Act (H.R. 4311), which includes these benefits in Medicare Part B.
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In light of these ongoing policy discussions, this brief provides new data on the share of Medicare beneficiaries with dental coverage, the share of dental visits in the past 12 months, and out-of-pocket costs for dental care. It also takes a closer look at the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021. We focus on Medicare Advantage plans because they have become the leading source of dental coverage among Medicare beneficiaries. Our analysis is based on multiple data sets, including a survey of current Medicare beneficiaries for information on dental visits and out-of-pocket dental costs, and Medicare Advantage enrollment and benefit files for data on individual Medicare Advantage plans. To present a more detailed picture of dental benefits than is available in these data sets, we examine the dental coverage offered by 10 geographically dispersed Medicare Advantage plans offered by different insurers with relatively high enrollment that offer dental benefits (see methodology and appendix for more information).
Nearly 24 million people, or about half (47%) of Medicare beneficiaries, had no form of dental coverage in 2019 (Figure 1).
The rest of Medicare beneficiaries have access to dental coverage through Medicare Advantage plans, Medicaid, and private plans, including employer-sponsored retiree plans and individually purchased plans.
In 2019, 29% of all Medicare beneficiaries had access to dental coverage through Medicare Advantage plans (including 3% of beneficiaries who were also eligible for Medicaid who had access to dental coverage through a Medicare Advantage plan). Another 16% had coverage through private plans. About 11% of Medicare beneficiaries had access to dental coverage through Medicaid (including those mentioned above who also have coverage under Medicare Advantage plans). With Medicare Advantage enrollment increasing, a growing share of Medicare beneficiaries have access to some dental coverage through their Medicare Advantage plan, so the share of all Medicare beneficiaries with some dental coverage is expected to be higher in 2021.
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A preliminary analysis of the 2016 Medicare Current Beneficiary Survey (MCBS) and other data sources found that nearly two-thirds (65%) of people on Medicare had no dental coverage that year. However, due to a data collection and processing problem later identified by CMS, the private dental coverage estimates from the MCBS were lower than they should have been by an unknown amount. CMS resolved this issue in 2017. Because of these and other methodological changes in our analysis, as explained in Methodology, estimates of the number of people with dental insurance may not trend toward the 2016 estimate.
Lack of dental care can worsen chronic medical conditions such as diabetes and cardiovascular disease, contribute to delayed diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits. Costs are covered by Medicare beneficiaries for these routine and other dental procedures.
In 2018, half of Medicare beneficiaries did not visit a dentist (47%)—with even higher rates among those who are black or Hispanic (68% and 61%, respectively) (Figure 2).
Looking by race and gender, we found that a higher proportion of black and Hispanic women (64% and 59%, respectively) had gone without a dental visit in the past year than white women (40%). The same pattern exists among men, with a higher proportion of black men (74%) and Hispanic men (64%) than white men (44%) without visiting a dentist.
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Beneficiaries with lower incomes are significantly less likely than beneficiaries with higher incomes to report a dental visit in the previous year. Nearly three-quarters (73%) of Medicare beneficiaries earning less than $10,000 a year did not visit a dentist, compared to 25% of beneficiaries earning more than $40,000.
Health status was also associated with dental care. Almost two-thirds (63%) of all beneficiaries with fair or poor self-esteem had a dental visit in the past year, compared to 41% of beneficiaries with good, very good or good health.
These relatively low dental utilization rates are not related to decreased utilization due to the COVID-19 pandemic, as they are based on data from 2018, the most recent year of availability prior to the pandemic.
Most beneficiaries who received dental care in 2018 (88%) paid for their care out of pocket. Across all beneficiaries, the average out-of-pocket cost for dental care in 2018 was $454, although this includes a large number of beneficiaries who had no dental care that year. Among the roughly half of Medicare beneficiaries who used any dental services, the average out-of-pocket cost for dental care in 2018 was $874. One in five beneficiaries who used dental services spent more than $1,000 on dental care, including one in ten who spent more than $2,000 (Figure 3).
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Medicare Advantage plans may provide additional ("add-on") benefits not covered by traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits can be covered by using discount dollars. Plans may also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans have access to dental coverage. The majority of Medicare Advantage enrollees (86%) had access to a broader coverage plan, while 14% had access to only preventive coverage. Preventative dental coverage in Medicare Advantage plans generally includes oral exams, cleanings, dental X-rays, and sometimes fluoride treatments. Broader benefits include a range of services including restorative services (eg fillings), endodontics (eg root canals), periodontics (eg scaling and root planning), prosthetics (eg dentures, dental implants) and oral surgery.
Almost all enrolled Medicare Advantage plans that offer access to dental benefits (even if they have to pay a premium for those benefits) have access to preventive services, including oral exams (100%), cleanings (100%), and x-rays (99%), although less registered have access to fluoride treatment (59%).
Service Limits. Medicare Advantage plans typically limit the frequency of receiving certain covered services at certain times. For example, nearly all enrollees (88%) are in 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-ray, frequency limits vary more between plans. For example, 36% of enrollees are in plans that limit the number of x-rays at a set time, with the most common limit being once a year.
Covered services (except preventive). Among enrollees in plans that offer access to broader services, the type of services covered varies among plans: 96% of enrollees are in plans that offer recovery services, such as refills; 83% are in plans that include withdrawals; 76% are in plans that cover periodontics and/or prosthetics; 64% are in plans that cover endodontics such as root canals; and 60% are in plans that cover diagnostic services and/or non-routine services. However, we did not examine frequency limits for broader services because these categories of services cover a wide variety of treatments and it is not always clear what an individual plan covers in each of these categories of services.
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As part of the Prosthetics service category, some beneficiaries may have access to coverage for prostheses, a service commonly required by seniors. As of 2018, nearly 14% of adults over the age of 65 are edentulous, meaning they have no natural teeth. We were unable to determine the specifics of denture coverage based on our analysis of national data, so take a closer look at the ten illustrative plans. Five of the ten plans specified that they covered dentures (partial and full), and each of these plans limited dentures to 1 set every 5 years (Appendix Table 1). Among these five
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