Expansion of dental benefits under the Medicare Advantage program

Abstract

Uninsured older adults are twice as likely to not receive needed dental care as their insured counterparts. Yet, nearly one-third of older adults have untreated dental caries, and older adults are more likely to have complete tooth loss, periodontal disease, and oral cancer. Moreover, persons sixty-five and older had the lowest percentage of individuals with dental insurance and the highest average out-of-pocket expenses of all persons with a dental visit in 2000. Given that retiree health benefits for large companies have declined from 66 percent in 1988 to 38 percent in 2003, it is unlikely that the private sector will increase funding for dental benefits for the elderly. However, some Medicare managed care plans already cover either preventive or comprehensive dental benefits. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created incentives for Medicare managed care plans to offer beneficiaries additional benefits, including dental. The First Seniority Dental Plan, described in this article, demonstrates that it is possible to create a dental plan that is affordable for the HMO, reimburses providers at reasonable rates, provides a reduction in costs to Medicare beneficiaries, and may present a method to expand dental benefits for elders of the future.