Traditional Medicare doesn’t cover most dental care, which leaves consumers with the option to enroll in Medicare Advantage that provides dental care as a supplemental benefit. Previous studies have observed high out-of-pocket costs and low dental utilization rates for beneficiaries under traditional Medicare as well as Medicare Advantage.
A recent analysis has determined that Medicare Advantage offers poor-quality dental coverage. Only about 8% of plans under this privatized form of Medicare provided dental benefits that met the study’s quality standards.
A team of researchers from Mass General Brigham conducted the analysis. For their study, the researchers assessed Medicare data from late 2023 then came up with a list of requirements for an inclusive dental benefit that’d be on the same level as plans sponsored by employers.
The requirements included having a yearly maximum coverage of no less than $1500, dental cleanings being offered at no additional charge, and not having to pay more in premiums to access dental services. The analysis included more than 6300 plans under Medicare Advantage, with total enrolment of over 27 million beneficiaries.
The researchers determined that while more than 86% of plans provided a dental benefit, only 8.4% provided comprehensive benefits of good quality. They also found that only 4.1% of 94% of beneficiaries under Medicare were enrolled in a plan with inclusive dental benefits.
These findings may explain why only about 50% of beneficiaries covered by Medicare Advantage visit the dentist yearly, which is similar to the proportion of beneficiaries covered by traditional Medicare who lack dental coverage.
Dr. Lisa Simon, the first author of this study, explained that their findings showed that many beneficiaries covered by Medicare Advantage didn’t have access to the dental care they required even though they were enrolled in a plan that nominally offered dental coverage. She noted that most of the requirements they evaluated like whether procedures like crowns or fillings were covered or how much coinsurance an individual would need to pay, were somewhat complicated and potentially overwhelming for individuals to review during open enrolment season.
Simon then noted that implementing stricter regulations could prevent Medicare Advantage plans from offering low-quality dental plans to consumers while also ensuring that consumers knew the benefits they’d accrue when they enrolled in a Medicare Advantage plan.
The researchers’ findings were reported in the Journal of the American Medical Association. Other researchers involved in the study included Kamyar Nasseh and Marko Vujicic.
In light of these findings, individuals need to contact specific MA providers like Astiva Health and ascertain that their different medical needs, such as dental cover, will be adequately addressed before choosing a provider to sign up with.
NOTE TO INVESTORS: The latest news and updates relating to Astiva Health are available in the company’s newsroom at https://ibn.fm/Astiva
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