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Low-Income Seniors Face Dental Care Gap

Despite offering supplemental dental benefits, Medicare Advantage plans are leaving lower-income seniors struggling with high out-of-pocket costs for essential dental, vision, and hearing services. New research reveals that even top-rated plans fall short in providing adequate financial protection for those most in need.

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A new study published in Health Affairs reveals that lower-income adults enrolled in Medicare Advantage plans face significant challenges in affording dental, vision, and hearing services, despite these benefits being included in their plans. Medicare Advantage, a popular alternative to traditional Medicare, offers supplemental benefits, such as dental care, which are largely funded by rebate dollars from the Centers for Medicare and Medicaid Services (CMS). However, for low-income beneficiaries, these benefits are often insufficient to cover costs, leaving them with unmet healthcare needs.

The research, which analyzed data from a 2018–19 survey of Medicare Advantage beneficiaries, found that nearly 11% of enrollees reported unmet dental needs due to cost. Lower-income beneficiaries were especially vulnerable, with significantly higher rates of cost-related barriers compared to higher-income individuals. Even among beneficiaries enrolled in high-quality Medicare Advantage plans with the highest star ratings, the gap in dental care access persisted. The researchers noted that while high star ratings improved dental coverage slightly, the same effect was not seen for hearing and vision care.

The study raises concerns about how CMS allocates rebate payments to Medicare Advantage plans, particularly regarding whether these funds effectively improve access to essential services. The researchers suggest that CMS should enhance its oversight and ensure that rebate dollars are better linked to the value of supplemental benefits, particularly for the most vulnerable populations. Click here to read more.

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