Study: Most MA beneficiaries don’t have access to quality dental care

Researchers from Mass General Brigham found that only 8.4 percent of Medicare Advantage plans offered a dental benefit that met quality standards.

Findings from a new study, published in JAMA and conducted by researchers from Mass General Brigham in Boston and the American Dental Association Health Policy Institute in Chicago, 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.

“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 lead author Lisa Simon, M.D., DMD, of the Division of General and Internal Medicine at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, in the study announcement

The team examined data from late 2023 of 6,333 Medicare advantage plans with a total enrollment of more than 27 million beneficiaries, Researchers 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-payment, having an annual maximum coverage of at least $1,500, and not requiring an additional premium to have access to these dental services). They found:

  • 86.6 percent of plans offered a dental benefit, but only 8.4 percent offered a comprehensive benefit that met quality standards. 
  • 94 percent of Medicare beneficiaries were enrolled in a plan that offered a dental benefit, but only 4.1 percent were enrolled in a plan with a comprehensive dental benefit.

“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 Dr. 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.”