Best Dental Insurance For Seniors On Medicare 2021

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Dental benefits are generally not covered by Medicare, except in limited circumstances, and many people on Medicare do not have dental coverage. Medicare beneficiaries have access to dental coverage through other sources, such as Medicare Advantage plans, but the coverage of dental benefits, when covered, varies widely and is often quite limited. , which As a result, these people may have a higher out-of-pocket. cost. Severe dental need or unmet need.

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Policymakers are now discussing options to make dental care more affordable by expanding dental coverage for people on Medicare. President Biden's fiscal year 2022 budget request includes "improving access to Medicare dental, hearing and vision coverage" as part of the president's health care agenda. Senate Democrats recently announced a deal to expand Medicare to include 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, in addition to provisions to lower prescription drug costs, would add dental benefits to Medicare Part B , along with visual and hearing benefits. will increase. . Earlier this year, Representative Doggett, along with 76 members of the House of Representatives, introduced the Medicare Dental, Vision, and Hearing Benefit Act (H.R. 4311) that would cover these benefits under Medicare Part B.

Medicare Dental Coverage

Because of ongoing debates over this policy, it provides new data on the share of Medicare beneficiaries with short dental coverage, the share on dental visits in the past 12 months, and out-of-pocket spending on care in the teeth. It also looks at the coverage of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021. Our analysis draws from multiple data sets, including the Medicare Current Benefit Survey for information on dental visits and out-of-pocket dental costs and the Medicare Advantage Enrollment and Benefit Files for data on individual Medicare Advantage plans. To provide 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 with relatively high enrollment among others' other insurers. are offered by providers of dental benefits (see Methods and Appendix for more information).

About 24 million people, or nearly half (47%) of Medicare beneficiaries, had no form of dental coverage in 2019 (Figure 1).

The remaining 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 some dental coverage through Medicare Advantage plans (including 3% of Medicaid-eligible beneficiaries who had access to dental coverage through Medicare Advantage plan). Another 16% had coverage through private plans. About 11% of Medicare beneficiaries have access to dental coverage through Medicaid (including those mentioned above who also have coverage through 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 Medicare beneficiaries with some dental coverage in 2021 will be higher. This is likely to happen.

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An earlier analysis of the 2016 Medicare Current Beneficiary Survey (MCBS) and other data sources indicated that nearly two-thirds of people on Medicare (65%) did not have dental coverage that year. However, due to a data collection and processing problem later identified by CMS, the estimates of private dental coverage obtained from the MCBS are lower than they should be by an unknown magnitude. CMS resolved this issue in 2017. Because of this and other methodological changes in our analysis, as described in the methodology, the number of people with Medicare dental insurance could not be estimated using our 2016 estimates.

Lack of dental care can exacerbate chronic medical conditions, such as diabetes and cardiovascular disease, contribute to delaying the diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly There are visits to emergency room. Promote routine and other dental procedures to Medicare beneficiaries.

In 2018, half of Medicare beneficiaries did not visit a dentist (47%)—with higher rates among blacks or Hispanics (68% and 61%, respectively) (Figure 2).

When we looked by race and gender, we found a higher proportion of black and Hispanic women (64% and 59%, respectively) than white women (40%) with no dental visits in the past year. . The same pattern held for men: a greater proportion of black (74%) and Hispanic (64%) men than white men (44%) went without a dental visit.

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Beneficiaries with low incomes were less likely to report a dental visit than beneficiaries with high incomes in the previous year. About three-quarters (73%) of Medicare beneficiaries with an annual income of less than $10,000 did not visit the dentist, compared to 25% of beneficiaries with an income of more than $40,000.

Health status is also related to dental care. Nearly two-thirds (63%) of all beneficiaries with fair or poor self-rated health had a dental visit in the past year, compared to 41% of beneficiaries with excellent, very good, or good health.

The 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 available, before the pandemic.

Most beneficiaries who received dental services in 2018 (88%) paid out of pocket for their care. Among all beneficiaries, an average of $454 was spent on dental care in 2018, although this included a large number of beneficiaries who had no dental care that year. With nearly half of Medicare beneficiaries using 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 treatment. maintenance, including one in ten who spent more than $2,000 (Figure 3).

Medicare Advantage In 2022: Premiums, Out Of Pocket Limits, Cost Sharing, Supplemental Benefits, Prior Authorization, And Star Ratings

Medicare Advantage plans may provide additional ("extra") benefits that traditional Medicare does not cover, such as dental, vision, hearing and health benefits. The cost of these benefits can be offset by dollar rebates. Plans may also charge additional premiums for such benefits. By 2021, 94% of enrollees in individual Medicare Advantage plans will have access to some dental coverage. The majority (86%) of these Medicare Advantage enrollees have access to a plan with broader coverage, while 14% have access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans often includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. Broader benefits cover a variety of services, including restorative services (eg, fillings), endodontics (eg, root canal), periodontics (eg, scaling and root planing), prosthodontics ( eg, dentures, dental implants), and Oral surgery.

Almost all Medicare Advantage plans that offer access to dental benefits (including if they have to pay a premium for those benefits), have access to preventive services, including oral exams (100%), sanitation (100%), and x-ray ( 99%), although fewer enrollees had access to fluoride treatment (59%).

Service Limitations. Medicare Advantage plans typically limit the frequency of receiving certain covered services during specified time periods. For example, nearly all enrollees (88%) were in plans with frequency limits on the number of cleanings, with the most common limit being twice per year. For other services, such as X-rays, frequency limits vary widely among plans. For example, 36% of enrollees are in plans that limit the number of X-rays to a specific time frame, with the most common limit being once a year.

Covered services (except custody). Among those enrolled in plans that offer access to broader services, the type of services covered varies among plans: 96% of enrollees are in plans that -offer rehabilitation services, such as fillings; 83% are in plans that cover withdrawals. 76% are in plans that cover periodontics and/or prosthodontics. 64% are in plans that cover endodontics, such as root canals; And 60% are in plans that include diagnostic services and/or non-routine services. However, we did not examine frequency ranges for broader services because these service categories cover different types of treatment, and it is not always clear what an individual plan covers within of each of these service categories.

Study: 99.9% Of Medicare Advantage Plans Offering Supplemental Benefits In 2022

As part of the prosthodontic service category, some beneficiaries may have access to dental coverage, a commonly needed service in the elderly. In 2018, about 14% of adults 65 and older were edentulous, meaning they had no natural teeth. We were unable to determine specifics on dental coverage based on a review of national data, so we looked in more detail at ten exemplary 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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