Nearly half of Medicare beneficiaries currently do not have dental coverage as of 2019 as Congress considers adding the benefit to the program, a new analysis finds.
The analysis from the Kaiser Family Foundation released Wednesday found that beneficiaries on average spent $847 in 2018 on out-of-pocket dental services. Senate Democrats have proposed adding dental, vision and hearing benefits to Medicare as part of a $3.5 trillion infrastructure package.
Kaiser’s analysis looked at 2019 Medicare and Medicare Advantage data to determine how many people could be helped by the addition of dental benefits.
It found that 23.6 million beneficiaries, 47% of all enrollees, didn’t have dental coverage in 2019. That same year, 26% of beneficiaries got coverage from an MA plan, 16% from a private plan, 8% from Medicaid and 3% from an MA and Medicaid plan.
Over the past year, 47% of Medicare beneficiaries didn’t go to the dentist.
If Congress does add the benefit, then it could save beneficiaries hundreds of dollars.
“One in five Medicare beneficiaries (20%) who used dental services spent more than $1,000 out-of-pocket on dental care,” the analysis said.
The MA program has been a continual source of dental coverage for enrollees. This year, nearly all (94%) of MA enrollees in individual plans, roughly 16 million enrollees, have access to some type of dental coverage, Kaiser found.
The analysis added that 86% of enrollees in those plans get both preventive and more extensive dental coverage.
But dental coverage does vary among MA plans. For example, Kaiser examined ten plans and found that five of the 10 plans covered dentures, with each limiting dentures to one set every five years.
“Among these five plans, cost-sharing imposed on beneficiaries for dentures ranges from no copayment to a $500 copayment and 50 to 70% coinsurance,” the analysis found.
It remains unclear if Congress will be able to pass the full $3.5 trillion package or if the additional benefits will be included. Senate leadership aims to pass the package via a procedural move called reconciliation, which enables budget bills to pass via a simple majority and bypass the 60 votes needed to break a filibuster.
The Senate is considering the $3.5 trillion package alongside a separate roughly $1 trillion bipartisan package on infrastructure.