For almost a decade, two-thirds of individuals and families who qualify for subsidized health insurance under the Patient Protection and Affordable Care Act (ACA) have been shopping for coverage through the Federally Facilitated Marketplace (FFM). The FFM platform provides consumers at varying income levels with access to their states’ qualified health plan and qualified dental plan offerings. An understanding of the current dental benefits landscape provides health insurers, dental insurers, regulators, and lawmakers alike with the insight to identify areas of strength and gaps in coverage and market options.
Using publicly available data for the 2020 plan year, this paper by Milliman’s Joanne Fontana and Alexandra Dowe highlights the landscape of dental coverage availability in the 38 states with the FFM. The authors also discuss key points regarding the national landscape of child and adult benefits in the individual market and highlight a few considerations that affect the ability of consumers to access coverage and make informed choices about dental care.
Medicare provides 61 million beneficiaries nationwide with
healthcare coverage. Dental services, however, 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 dental benefits can range from basic preventive dental care to comprehensive coverage of all major dental services categories, can come as a value-added “free benefit” in a zero-premium MA plan, can be embedded in an MA plan carrying a premium, or can be offered as an optional “buy-up” benefit. The dental benefits offered in an MA setting may be administered by the MA plan itself or as part of a contracted arrangement with a dental insurer.
In this article, Milliman’s Joanne Fontana and Jacob Bryniarski, using publicly available data from the Centers for Medicare and Medicaid Services (CMS), explore the current landscape of dental benefits offered in MA plans and discuss the ramifications for both insurers and consumers.