Study shows poor quality of dental coverage under Medicare Advantage

Medicare Advantage, the privatized version of Medicare that often includes additional benefits like dental coverage, has become increasingly popular among beneficiaries.

However, a recent study published in JAMA by researchers from Mass General Brigham reveals a significant shortfall in the quality of dental coverage offered by these plans.

Despite the appeal of added benefits, the analysis found that only 8.4% of Medicare Advantage plans provide dental coverage meeting comprehensive quality standards.

Led by Dr. Lisa Simon, a physician and dentist at Brigham and Women’s Hospital, the research team analyzed Medicare Advantage plans as of late 2023. They developed a set of benchmarks for what constitutes a high-quality dental benefit.

These benchmarks included essential features such as dental cleanings without a co-pay, annual maximum coverage of at least $1,500, and no additional premiums required for accessing these services. The goal was to compare the dental benefits of Medicare Advantage plans to those typically found in employer-sponsored plans.

Out of 6,333 Medicare Advantage plans reviewed, which collectively serve over 27 million enrollees, 86.6% included some form of dental benefit. However, only 8.4% met the comprehensive standards established by the researchers.

Moreover, while 94% of Medicare beneficiaries were enrolled in a plan offering dental benefits, just 4.1% had access to plans meeting these higher standards.

These findings may explain why dental care utilization among Medicare Advantage beneficiaries remains low. Only about half of beneficiaries visit the dentist annually, a rate comparable to that of traditional Medicare enrollees, who generally lack dental coverage.

This suggests that even when dental benefits are available, their limited quality may hinder meaningful access to care.

Dr. Simon emphasized that many beneficiaries likely find it challenging to navigate the complexities of dental plan offerings during open enrollment.

Factors like coinsurance costs, coverage for procedures such as fillings or crowns, and annual coverage limits can be difficult for consumers to evaluate and compare effectively.

The study raises questions about the adequacy of current regulations governing Medicare Advantage plans. Simon and her colleagues suggest that stronger regulations could prevent low-quality dental plans from being marketed and ensure beneficiaries understand the scope of their coverage.

By addressing these issues, policymakers could improve access to necessary dental care for millions of older adults.

This research underscores the critical importance of aligning Medicare Advantage dental benefits with the actual needs of beneficiaries.

Comprehensive dental care is essential for maintaining overall health, particularly for older adults, who are at greater risk for oral health issues that can affect their quality of life. The findings highlight an urgent need for reforms to ensure that Medicare Advantage plans deliver on their promise of enhanced benefits.

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The research findings can be found in JAMA.