Dental health benefit considerations for Medicare Advantage plans

Traditional Medicare Parts A and B cover hospital and physician services, respectively, and Medicare Part D may be purchased to cover prescription drugs. But dental services are not included in standard Medicare benefits. As such, seniors and other Medicare recipients can face a dental coverage gap.

Part C Medicare Advantage (MA) plans are helping to fill that gap by covering some dental services as a supplemental benefit. MA plans offer at least the same covered services as Parts A and B in a managed care setting, and the savings associated with the managed care arrangement generate rebates that can be used to reduce or eliminate beneficiary premiums for prescription drug coverage. Those rebates can also be used to offer other supplemental benefits including dental, vision, hearing, Part D premium buy-downs, and similar value-added services, at low or no additional premium to the beneficiary. MA dental benefits can range from basic preventive dental care to comprehensive coverage of all major dental service categories, can come as a value-added “free benefit” in a zero-premium MA plan, or can be embedded in an MA plan carrying a premium. They can also be offered as a supplemental benefit.

MA plans provide dental benefits to nearly 10 million people. In making the decision to offer dental coverage, MA plans must weigh the added cost of the benefits against the added value to the consumer.

In this paper, Milliman’s Joanne Fontana explores the current landscape of dental benefits offered in MA plans and discusses the ramifications for both insurers and consumers.

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