Dental coverage provided by Medicare Advantage, the privatized version of the healthcare insurance, may be subpar, according to a recent study conducted by Massachusetts-based healthcare system Mass General Brigham.
Only 8.4% of plans offered dental benefits that met the quality standards set by the research team. This finding suggests that many beneficiaries may not have access to the dental care they need despite being enrolled in plans that claim to offer appropriate coverage, according to the study.
The researchers examined Medicare data from 2023 and developed a list of criteria for what a comprehensive dental benefit should include. These criteria were based on the benefits offered by employer-sponsored plans and included services like free cleanings, an annual coverage maximum of at least $1,500, and no extra premium charges.
Although 94% of Medicare beneficiaries were enrolled in plans with dental benefits, only 4.1% were in plans with comprehensive coverage. This may explain why only about half of Medicare Advantage beneficiaries visit the dentist annually, a rate like those in traditional Medicare, which lacks most dental coverage, according to the study.
Many aspects of dental plans, such as co-insurance costs and coverage for procedures like fillings or crowns, can be complex and difficult for consumers to navigate during open enrollment. The research team suggests that stronger regulations are needed to prevent low-quality dental plans from being offered and to ensure that beneficiaries understand what they are receiving.
