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Life Health > Health Insurance > Medicare Planning

Medicare Advantage Plans Fill Dental Benefits Cavity: HealthScape

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What You Need to Know

  • 94% of Medicare Advantage enrollees now have access to preventive dental benefits.
  • 69% have gum care benefits.
  • 54% have annual dental maximums of $1,500 or higher.

Medicare Advantage plan issuers are taking a stand: They are agreeing that the teeth are an important part of a patient’s body, and that caring for them matters.

The percentage of Medicare Advantage enrollees with access to preventive dental services has increased to 94% this year, from 76% in 2018, according to a Medicare plan benefits analysis created by HealthScape Advisors, a Chicago-based consulting firm.

The percentage with built-in access to periodontic care — gum care — has increased to 69%, from 22%, over that same period.

What It Means

The original Medicare program does not cover routine dental care.

Insurers have been reluctant to sell true dental insurance on a voluntary basis to anyone, and especially to older people, who are likely to already need significant amounts of restorative care.

The result is that, in many cases, people ages 65 and older have had to make do with plans that provide prenegotiated, discounted rates for dental care, but no actual dental insurance.

Because of the lack of dental insurance, millions of older Americans skimp on dental care. Even affluent older Americans, who could easily pay for cleanings out of pocket, are often penny wise and pound foolish. They miss cleanings and exams, develop gum disease, and, possibly, suffer from loss of teeth, poor nutrition, and even strokes and heart attacks as a result of poor oral health.

Medicare Advantage vs. Original Medicare

Many clients and health care providers strongly prefer the flexibility of using original Medicare together with Medicare supplement insurance to Medicare Advantage, but Medicare Advantage plan issuers’ addition of dental benefits could eventually save the lives of some of the 29 million people who now have Medicare Advantage program coverage.

The administration of President Joe Biden has tried to close the dental benefits gap for the 35 million Medicare enrollees outside of the Medicare Advantage plan by offering proposals to add dental benefits to the original Medicare benefits package.

At this point, the future of the Medicare dental benefits proposal is uncertain. Many Republicans and Sen. Joe Manchin, D-W.Va., have pointed to Medicare’s solvency problems and questioned whether Medicare can afford to add dental benefits at this time.

The American Dental Association has also opposed adding dental benefits to the original Medicare program, because of concerns about how that change might affect reimbursement rates for dental care.

Spending Caps

One issue HealthScape looked at is the nature of the benefits Medicare Advantage plans really offer.

The firm’s analysts found that 31% of the plans with dental benefits have no annual spending maximums for those benefits.

About 54% of the plans studied have no annual maximum or an annual maximum over $1,500, and 77% of the plans provide at least $1,000 in dental benefits per year.

HealthScape serves the Medicare Advantage plan issuers, and it’s advising the issuers to offer as a wide a range of dental services as possible within a given category, to make sure dental benefits are seen as a “delighter,” not as a frustrating “detractor.”

(Image: Centers for Medicare and Medicaid Services)


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