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Close to half of all Medicare beneficiaries, totaling around 24 million people, did not have dental coverage in 2019, and the same percentage did not have a dental visit within the past year, according to a new analysis published by the Kaiser Family Foundation.
The numbers point to disparities around race and socioeconomic status, as those lacking dental insurance were seen in higher rates among Blacks (68%) or Hispanics (61%), those who had low incomes (73%), or those who were in fair or poor health (63%), as of 2018.
Average out-of-pocket spending on dental services among Medicare beneficiaries who had any dental service was $874 in 2018. One in five Medicare beneficiaries who used dental services spent more than $1,000 out-of-pocket on dental care.
Meanwhile, in 2021, 94% of Medicare Advantage enrollees in individual plans are in a plan that offers access to some dental coverage. Among these Medicare Advantage enrollees, 86% are offered both preventive and more extensive dental benefits.
More than three in four Medicare Advantage enrollees who are offered more extensive coverage are in plans with annual dollar limits on dental coverage, with an average limit of $1,300 in 2021; more than half (59%) of these enrollees are in a plan with a maximum dental benefit of $1,000 or less.
Nearly two-thirds of enrollees (64%) with access to preventive benefits, such as oral exams, cleanings and/or x-rays, pay no cost sharing for these services, though their coverage is typically subject to an annual dollar cap.
The most common coinsurance for more extensive dental services, such as fillings, extractions and root canals is 50%. Meanwhile, about 10% of Medicare Advantage beneficiaries are required to pay a separate premium to access any dental benefits.
WHAT’S THE IMPACT?
Without dental coverage, many people on Medicare forgo needed and routine dental care – an issue that disproportionately impacts communities of color – with significantly fewer visits to the dentist in the past year among Black and Hispanic beneficiaries compared to white beneficiaries.
Untreated oral health can exacerbate certain chronic diseases, delay diagnosis of serious health conditions and result in costly emergency visits, KFF found. And among beneficiaries who have the ability to pay for dental treatment, many experience high out-of-pocket costs, with 20% of people spending more than $1,000 out-of-pocket on dental care.
Medicare Advantage plans are the leading source of dental coverage for people with Medicare. While the scope of dental coverage varies across Medicare Advantage plans, there are some common features: Virtually all MA enrollees with access to dental coverage as part of their plan have preventive benefits, and most have access to more extensive dental benefits, though cost sharing for more extensive services is typically 50% for in-network care, and subject to an annual cap on plan payments.
About 78% of enrollees with access to more extensive services are subject to annual caps – averaging about $1,300 in 2021.
THE LARGER TREND
Medicare open enrollment numbers from December 2020 showed that more consumers chose Medicare Advantage plans for this year due to the plan’s supplemental benefits.
That came as no surprise, since private plans have pushed the supplemental benefits of their MA plans through television and other advertising, including numerous mailings, in a way the Centers for Medicare and Medicaid Services does not do for traditional Medicare.
MA plans continued to increase their supplemental benefit offerings in 2021, including meals and transportation to physician visits and coverage of over-the-counter drugs and wellness, benefits not covered under Medicare Part A, Part B or Part D. The drawback has always been the narrower networks of MA plans compared to traditional Medicare.