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Lobbying Group Cautions on Adding Dental, Vision Coverage to Medicare

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What You Need to Know

  • About 27 million Americans use Medicare Advantage, according to AHIP.
  • Medicare Advantage plans could have an average of 48% to 73% fewer rebate dollars available, Wakely Consulting Group found.
  • Some 98% of Medicare-eligible people have access to an MA plan that offers dental, vision and hearing coverage.

If Congress decides to add new health care services to original Medicare, it must be done without harming the 27 million Americans who have Medicare Advantage, AHIP, an advocacy group for providers of health care coverage, services and solutions, said in a statement this week.

AHIP funded an analysis by Wakely Consulting Group of the effect of mandating specified coverage for dental, hearing and vision services by all Medicare Advantage organizations.

Wakely found that if Congress adds these benefits to original Medicare without adjusting the Medicare Advantage benchmark, an MA plan would have an average of 48% to 73% fewer rebate dollars available to fund benefits like transportation, meals, in-home services and over-the-counter medicines, that 41% of Medicare-eligible Americans have come to rely on. 

That amounts to between $970 and $1,056 a year, according to the advocacy group.

The MA benchmark is a base rate against which a health insurance provider submits an MA plan bid to the Centers for Medicare & Medicaid Services, proposing the coverage and benefits for, and payments to, the plan for the benefit year. The benchmark is based on what the equivalent costs would be for the Medicare program if the person were enrolled in traditional, or fee-for-service, Medicare.

“Asking 27 million Americans to pay for new dental, vision, and hearing benefits in lieu of services they affirmatively chose and have come to rely on is unnecessary and unfair,” AHIP’s president and CEO, Matt Eyles, said in the statement.

According to AHIP, 98% of people eligible for Medicare have access to an MA plan that offers dental, vision and hearing coverage.

They can also choose to have coverage for dental, vision and hearing through individual dental policies, Medicare Supplement (Medigap) policies with such coverage, employer-provided coverage for working seniors and the Medicaid program in states where adult dental coverage is provided.

Besides the cost in terms of lost benefits, Wakely’s analysis found that not adjusting the MA benchmark could affect other factors of value for Americans. For example, as of February, about 58% of all MA members (excluding prescription drug plans) were enrolled in plans with a $0 member premium. 

Wakely said adding dental, vision and hearing benefits without an MA benchmark adjustment would limit the ability to maintain plans with a $0 premium.