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Oral Health in Medicare: Kaiser Family Foundation Releases Issue Brief Kaiser Family Foundation recently released an issue brief, Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries that examines the state of oral health for Medicare beneficiaries, including use of dental services and out-of-pocket spending. Medicare currently does not cover routine dental care, and the majority of people with Medicare have no oral health coverage at all. This leads to high out-of-pocket costs and foregone oral health care. The issue brief also discusses the means of coverage, along with scope of coverage and costs, for those Medicare beneficiaries who have access to oral health coverage through Medicare Advantage plans, Medicaid or private plans. Some key findings from the issue brief:

  • Almost two-thirds of Medicare beneficiaries (65%), or nearly 37 million people, do not have dental coverage.
  • Almost half of all Medicare beneficiaries did not have a dental visit within the past year (49%), with higher rates among those who are black (71%) or Hispanic (65%), have low incomes (70%), and are living in rural areas (59%) (as of 2016).
  • Almost one in five Medicare beneficiaries (19%) who used dental services spent more than $1,000 out-of-pocket on dental care in 2016.
  • Older adults have high rates of untreated caries and periodontal disease, which negatively affect oral and overall health: more than 14% of older adults have untreated caries and about 2 in 3 (68%) have periodontal disease.
  • In 2016, 60% of Medicare Advantage enrollees, or about 10.2 million beneficiaries, had access to some dental coverage. The remaining 40% of all Medicare Advantage enrollees, or almost 7 million beneficiaries, did not have access to dental coverage under their plan.
  • Some Medicare Advantage plans charge an additional premium for dental benefits, and enrollees must pay that premium in order to receive the dental coverage. Overall, almost three in ten (29%) Medicare Advantage enrollees with access to dental benefits under their plan may be required to pay a monthly premium, averaging $284 per year in 2016, for the plan dental benefits.
  • Of the 7 million Medicare Advantage enrollees in plans that offered both preventive and more extensive dental benefits, about four in ten (43%) are in plans with dollar limits on coverage, and most plans had limits around $1,000. In addition to dollar limits, Medicare Advantage plans typically limit the number of services covered.
  • Among full dual eligibles, almost nine in ten (88%) lived in a state where they were eligible for some dental benefits from Medicaid, although the range in covered benefits varies significantly across states.
  • Poor oral health is associated with potentially preventable and costly emergency department (ED) visits, with more than 2 million visits to the ED each year among people of all ages due to oral health complications.

The KFF Issue Brief available at: The Center for Medicare Advocacy’s oral health work:

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