Only 8.4% of Medicare Advantage Offer Dental Coverage

Medicare Advantage, the privatized version of Medicare offering additional benefits like dental coverage, is increasingly popular among beneficiaries. However, a recent study by Mass General Brigham, published in JAMA, highlights a significant issue: the quality of dental benefits provided by many Medicare Advantage plans is subpar. According to the research, only 8.4% of plans offered dental health coverage that met the quality standards set by the study.

The analysis, which examined data from over 6,300 Medicare Advantage plans with a total enrollment of more than 27 million beneficiaries, reveals that while 86.6% of plans offer some form of dental health coverage, only a small percentage provide a comprehensive benefit. The study’s authors, led by Lisa Simon, MD, DMD, of Brigham and Women’s Hospital, found that most plans fall short of offering essential dental services like annual cleanings without co-pays or coverage for major procedures like fillings or crowns.

In fact, the research indicates that 94% of Medicare beneficiaries are enrolled in plans with some dental benefit, but just 4.1% have access to a comprehensive dental plan. This gap may help explain why only about half of Advantage beneficiaries visit the dentist each year—a rate comparable to those in traditional Medicare, which generally lacks dental health coverage.

Simon points out that many aspects of dental benefits, such as co-insurance costs and coverage for procedures like crowns, can be difficult for consumers to understand, especially during the complex open enrollment season. The study calls for better regulations to prevent low-quality dental plans from being offered and to ensure consumers are fully informed about what their Medicare Advantage plans provide.

More Information: Simon L et al. Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County, JAMA (2024). DOI: 10.1001/jama.2024.24814