Diving into Medicare dental benefits

One of the selling points for private Medicare Advantage insurance plans is their coverage of routine dental, hearing, and vision benefits. Original Medicare does not cover routine dental care but does cover a limited number of dental procedures linked to serious health issues, including dental services relating to kidney transplants and radiation treatments. Late last year, the Centers for Medicare & Medicaid Services (CMS) slightly broadened the scope of dental procedures that Original Medicare will cover.

The absence of comprehensive dental care has been cited by some Medicare advocates as a major program deficiency.

The Medicare Rights Center believes that CMS has the authority on its own to broaden the definition of “medical necessity” that governs coverage decisions, and that doing so could save billions of dollars in the long run.

In 2019, nearly 24 million people – 47% of people with Medicare – didn’t have dental coverage.

The CMS changes, which apply to small numbers of people, will permit Medicare to make payment for some dental services needed to successfully provide other care that is covered. Expanded coverage this year applies to organ transplant surgery and cardiac valve replacements. Next year, Medicare will provide coverage for dental services related to head and neck cancers.

By contrast, most private Medicare Advantage (MA) insurance plans do cover routine dental care, and this benefit is seen as a major drawing card.

According to the Kaiser research, 94% of MA members had access to some dental coverage in 2021.

Other details of MA enrollees with access to dental coverage:

• 86% of these enrollees are offered both preventive and more extensive dental benefits
• 78% of these enrollees with more extensive coverage are in plans with annual dollar limits on dental coverage, with an average limit of $1,300 in 2021
• 59% of these enrollees are in a plan with a maximum dental benefit of $1,000 or less

Whether it’s Original Medicare or MA, older adults are interested in making sure their dental needs are met. According to a recent survey, nearly 80% of older adults are surprised by what’s not covered by their dental benefit.

Finally, benefit usage matters. A study in the February issue of Health Affairs found that MA enrollees did not use dental services more than Original Medicare members. The study did not look at health differences between MA and Original Medicare enrollees, which could explain variations in use of dental services.