By Kathleen Kennedy-Luczak, J.D.
President Biden’s FY 2022 budget request includes as part of the healthcare agenda "improving access to dental, hearing, and vision coverage in Medicare."
A recent issue brief by the Kaiser Family Foundation (KFF) looks at new data on the share of Medicare beneficiaries with dental coverage, the share who have had a dental visit in the past 12 months, and out-of-pocket spending on dental care. The brief, based on data from various sources, including the 2018 and 2019 Medicare Current Beneficiary Survey and CMS Medicare Advantage Enrollment and Benefit files for 2019 and 2021, also highlights the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021.
Lack of coverage. Since its inception in 1965, Medicare has not covered routine dental care, except under limited circumstances. Some Medicare beneficiaries have access to dental coverage through other sources, such as Medicare Advantage plans. However, the scope of dental benefits, when covered, varies widely and is frequently quite limited. Consequently, individuals can have high out-of-pocket costs for dental care.
According to the brief’s authors, nearly half of all Medicare beneficiaries (47 percent), or 24 million people, do not have dental coverage, as of 2019. The remaining Medicare beneficiaries have access to dental coverage through Medicare Advantage plans, Medicaid, and private plans.
Risks associated with lack of care. The brief found that, as of 2018, almost half of all Medicare beneficiaries did not have a dental visit within the past year (47 percent). The rates among Medicare beneficiaries who are Black or Hispanic were even higher, 68% and 61 percent, respectively, as were rates among those who have low incomes (73 percent) or who are in fair or poor health (63 percent).
A lack of dental care can exacerbate chronic medical conditions, such as diabetes and cardiovascular disease, contribute to the delayed diagnosis of medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits. Likewise, the report notes, limited or no dental coverage and cost concerns contribute to Medicare beneficiaries foregoing routine and other dental procedures.
Out-of-pocket spending. Most beneficiaries who received dental services in 2018 (88 percent) paid out of pocket for their care.
Medicare Advantage benefits. Medicare Advantage plans may provide supplemental benefits that are not covered under traditional Medicare, such as dental benefits. The brief examined dental coverage offered by 10 geographically dispersed Medicare Advantage plans offered by different insurers and reported that, in 2021, 94 percent of Medicare Advantage enrollees in individual plans are in a plan that offer some dental coverage. Among these enrollees:
- 86 percent are offered both preventive and more extensive dental coverage.
- 78 percent enrollees offered more extensive coverage are in plans with annual dollar limits on dental coverage, with an average limit of $1,300 in 2021.
- 64 percent with access to preventive benefits, such as exams, cleanings, and/or x-rays, pay no cost sharing for these services, though the coverage is typically subject to an annual dollar cap.
- The most common coinsurance for more expensive services, such as fillings, extractions, and root canals, is 50 percent.
- About 10 percent are required to pay a separate premium to access the dental benefits.
Current proposals. As stated in the brief, policymakers are currently discussing options to make dental care more affordable by broadening dental coverage for individuals on Medicare. In addition to President Biden’s FY 2022 budget request, other proposals include:
- In the 116th Congress, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R. 3), which among other provisions, provided for dental coverage under Part B of the Medicare program, starting in 2025 if enacted into law. However, the recently reintroduced version of H.R. 3 does not include coverage for a dental benefit.
- As introduced in July 2021 by Representative Doggett, the Medicare Dental, Vision, and Hearing Benefit Act (H.R. 4311) that would provide dental coverage under Medicare Part B. The proposal would require no coinsurance for preventive services and impose a 20% coinsurance for more extensive benefits.
Benefit design. The KFF issue brief concludes that, given the continued interest in adding dental benefits to Medicare, policymakers will need to weigh a variety of factors in designing the benefit, including scope of covered benefits, cost sharing for specific services, and how different levels of coverage may impact Medicare costs and premiums.
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