Dental Coverage in Medicare Advantage Plans Varies by Demographic
Beneficiaries 64 or younger, dual-eligibles, and those in racial or ethnic minority groups were more likely to have Medicare Advantage plans with dental coverage.
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- Almost a third of beneficiaries had a Medicare Advantage plan that didn’t offer dental coverage in 2019, but coverage was more common among historically underserved populations, a study published in JAMA Network Open revealed.
Traditional Medicare generally does not cover oral health services, while most Medicare Advantage plans include this coverage as a supplemental benefit. Beneficiaries in racial and ethnic minority groups and with lower socioeconomic status are less likely to have recent dental visits, but Medicare Advantage enrollment among these populations is high.
Researchers used dental benefits data from the CMS 2019 Plan Benefit Package and the 2019 Master Beneficiary Summary File to assess the likelihood of having Medicare Advantage plans with dental coverage among beneficiaries by sociodemographic factors. Dental coverage was categorized as no coverage, preventive only, or comprehensive.
In 2019, 21.2 million beneficiaries had 12 months of Medicare Advantage coverage. Among these beneficiaries, 32.7 percent had a Medicare Advantage plan with no dental coverage, 14.0 percent had plans with preventive coverage only, and 53.3 percent had comprehensive coverage.
The majority of beneficiaries with a higher prevalence of no dental coverage were 75 years or older (36.8 percent), White (34.9 percent), not dually eligible for Medicare and Medicaid (37.3 percent), and qualified for Medicare due to age (36.7 percent).
The likelihood of having plans that offered dental coverage varied across demographic groups, the study found. For example, beneficiaries 64 years or younger had higher odds of having dental coverage compared to those between 65 and 74. Additionally, racial and ethnic minority beneficiaries had a higher likelihood of having dental coverage than White beneficiaries.
Dual-eligible beneficiaries had higher odds of having plans with dental coverage compared to non-dual-eligibles. People who qualified for Medicare because of a disability also had higher odds than those qualifying due to age.
As of January 2023, 50 percent of all Medicare beneficiaries were enrolled in Medicare Advantage plans. KFF data found that in 2021, Medicare Advantage beneficiaries were more likely than traditional Medicare beneficiaries to be Black or Hispanic, low-income, have low levels of education, and live in urban areas—a trend that has continued.
Although these historically underserved populations are more likely to go without dental care, the JAMA study suggests that enrolling in Medicare Advantage plans with dental coverage has helped minimize this disparity.
Supplemental benefits like dental and vision services are common offerings from Medicare Advantage plans, but plans can provide non-medical supplemental benefits, too. The expanded definition of primarily health-related supplemental benefits and the 2018 CHRONIC Care Act allow plans to offer special supplemental benefits for the chronically ill and additional non-medical benefits.
A report from ATI Advisory found that food and produce services are the most common non-medical supplemental benefit in Medicare Advantage in 2024. These benefits can include produce, frozen foods, and canned goods. Plans are also offering transportation benefits, social needs benefits, and home healthcare services.
