Proposed Policy Would Boost Access to Medicare Dental Benefits

Updated 9/13/21: This article has been updated to reflect that AHIP has taken a stance regarding the potential outcomes if the proposed policy passes. A previous version of the article incorrectly stated that the payer organization had taken a stance against the proposed policy.

If Congress passed Medicare dental benefits coverage, which has been proposed in the 2022 budget, access to dental care would increase and with high dental healthcare spending would face lower costs, an Urban Institute report found.

To analyze the potential impact of this policy, the researchers relied on data from the Medical Expenditure Panel Survey from 2015 through 2018 as well as from the 2015 Medicare Current Beneficiary Survey (MCBS).

The researchers isolated a couple of major trends in seniors’ dental healthcare utilization and costs. They found that dental healthcare spending is particularly high for adults between the ages of 65 and 79. Seniors who were 70 to 75 years old spent around $532 per year on dentist work, compared to $198 annually for adults in their twenties.

Utilization fluctuated in tandem with spending, dropping to 0.6 visits to the dentist’s office per year for adults ages 20 to 29 and then nearly doubling to 1.2 visits per year or more between the ages of 60 and 79. Most of the dental services that seniors used were preventive care services, such as cleanings and exams.

The share of the costs that seniors shouldered also increased with time. Adults under 50 years old on average cover less than 40 percent of their dental costs, whereas beneficiaries 65 and older often pay 58 to 75 percent of their more expensive dental costs.

Spending was higher for Medicare beneficiaries in fee-for-service Medicare than those in Medicare Advantage plans. Despite no major difference in dental visits, seniors with coverage through fee-for-service Medicare spent on average around $62 more annually—$506 per year for fee-for-service beneficiaries, compared to $444 for Medicare Advantage beneficiaries.

The researchers also noted a lack of health equity in Medicare’s dental coverage trends. Over half of the people who used dental healthcare services in 2020 identified as White individuals. Meanwhile, Black beneficiaries and Hispanic beneficiaries made up 35.0 percent and 37.8 percent of the dental healthcare events in 2020.

“Spending for Black enrollees is low not just compared with white enrollees but also compared with other racial and ethnic groups,” the researchers explained. 

“This could reflect the greater likelihood of Black enrollees having Medicaid coverage, which covers more of the cost of dental services. However, this does not seem to result in greater access to or use of dental services. In addition, Hispanic enrollees are just as likely to be covered by Medicaid, so this cannot be the full explanation.”

Economic status also seemed to make a difference as to whether or not a beneficiary used dental services under Medicare. Lower-income individuals spent less on their dental health than higher-income individuals. Aligned with this trend, spending tends to be lower for dual eligible individuals, but Medicaid picks up a higher share of the cost.

“Dental benefits that provide basic coverage for preventive services can benefit many Medicare beneficiaries who do not currently use dental care, but basic benefits will not provide relief for these high-cost dental procedures,” the researchers concluded. 

“If Medicare dental services are to be targeted to those with the greatest need, protection against the high cost of these extensive procedures seems essential.”

AHIP made clear that this policy would reduce Medicare Advantage rebates.

“MA is popular because it delivers better health and great value for seniors and people with disabilities,” Matt Eyles, president and chief executive officer of AHIP, said in the AHIP press release. “Tens of millions of MA seniors should not pay the price for improving traditional Medicare.”

Vision, hearing, and dental benefits were among the top benefits that Medicare Advantage plans offered in plan year 2021.

Over six in ten Medicare Advantage enrollees (62 percent) named dental benefits as their primary reason for enrolling in a Medicare Advantage plan, a separate survey discovered.