Investigation uncovers poor quality of dental coverage under Medicare Advantage

Medicare Advantage—the privatized form of Medicare that offers benefits beyond traditional Medicare, such as dental insurance—is gaining in popularity, but a new analysis reveals that the quality of dental coverage offered by Medicare Advantage is poor, with only 8.4% of plans offering a dental benefit that met the study’s quality standards.

The research led by a team from Mass General Brigham is published in JAMA.

“Our study suggests that many Medicare Advantage beneficiaries may not have access to the dental care they need, even if they are enrolled in a plan that nominally provides them with dental coverage,” said first author Lisa Simon, MD, DMD, of the Division of General and Internal Medicine at Brigham and Women’s Hospital.

Simon and her colleagues examined Medicare data from late 2023, and they developed a list of requirements for a comprehensive dental benefit that would be on par with employer-sponsored plans (such as offering dental cleanings without a co-pay, having an annual maximum coverage of at least $1,500, and not requiring an additional premium to have access to these dental services).

The team’s analysis included 6,333 Medicare advantage plans with a total enrollment of more than 27 million beneficiaries. The investigators found that 86.6% of plans offered a dental benefit, but only 8.4% offered a comprehensive benefit that met quality standards.

Also, 94% of Medicare beneficiaries were enrolled in a plan that offered a dental benefit, but only 4.1% were enrolled in a plan with a comprehensive dental benefit.

These research findings might explain why only about half of Medicare Advantage beneficiaries visit the dentist annually, which is similar to the rate for beneficiaries in traditional Medicare that lacks most dental coverage.

“Many of the attributes we studied—like how much coinsurance a patient would need to pay or whether procedures like fillings or crowns are covered—are fairly complex and probably pretty overwhelming for consumers to review during open enrollment season,” said Simon.

“Regulations could prevent low-quality dental plans from being offered in the first place and ensure that consumers actually know what they’re getting when they pick a Medicare Advantage plan.”

Medicare Advantage—the privatized form of Medicare that offers benefits beyond traditional Medicare, such as dental insurance—is gaining in popularity, but a new analysis reveals that the quality of dental coverage offered by Medicare Advantage is poor, with only 8.4% of plans offering a dental benefit that met the study’s quality standards.

The research led by a team from Mass General Brigham is published in JAMA.

“Our study suggests that many Medicare Advantage beneficiaries may not have access to the dental care they need, even if they are enrolled in a plan that nominally provides them with dental coverage,” said first author Lisa Simon, MD, DMD, of the Division of General and Internal Medicine at Brigham and Women’s Hospital.

Simon and her colleagues examined Medicare data from late 2023, and they developed a list of requirements for a comprehensive dental benefit that would be on par with employer-sponsored plans (such as offering dental cleanings without a co-pay, having an annual maximum coverage of at least $1,500, and not requiring an additional premium to have access to these dental services).

The team’s analysis included 6,333 Medicare advantage plans with a total enrollment of more than 27 million beneficiaries. The investigators found that 86.6% of plans offered a dental benefit, but only 8.4% offered a comprehensive benefit that met quality standards.

Also, 94% of Medicare beneficiaries were enrolled in a plan that offered a dental benefit, but only 4.1% were enrolled in a plan with a comprehensive dental benefit.

These research findings might explain why only about half of Medicare Advantage beneficiaries visit the dentist annually, which is similar to the rate for beneficiaries in traditional Medicare that lacks most dental coverage.

“Many of the attributes we studied—like how much coinsurance a patient would need to pay or whether procedures like fillings or crowns are covered—are fairly complex and probably pretty overwhelming for consumers to review during open enrollment season,” said Simon.

“Regulations could prevent low-quality dental plans from being offered in the first place and ensure that consumers actually know what they’re getting when they pick a Medicare Advantage plan.”