Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries

Data and Methods

This analysis uses data from the Medicare Current Beneficiary Survey (MCBS), 2016; Medicare Chronic Conditions Data Warehouse data from 5 percent of beneficiaries (5% Sample), 2016; and CMS Medicare Advantage Enrollment, Benefit, and Landscape files, 2016, with enrollment data from March of that year and excluding Puerto Rico. The analysis also uses data from the National Health Interview Survey (NHIS), 2017; National Health and Nutrition Examination Survey (NHANES), 2013-2016; Kaiser Family Foundation database of Medicaid Dental Benefits, 2018; and Center for Health Care Strategies’ (CHCS) Medicaid Adult Benefits data, 2018.

To determine dental coverage in Figure 7, we combined data from multiple sources. The 5% Sample and the Medicare Advantage Benefit files were used to determine the number of Medicare Advantage enrollees with access to dental coverage. Both data sets were restricted to beneficiaries with both Parts A and B in March of 2016 and excluded US territories. The 5% Sample, combined with data from the KFF database of Medicaid Dental Benefits and CHCS, was used to calculate the number of dual eligibles with some dental coverage based on whether they lived in a state that offered dental benefits through Medicaid. 2016 is the most recent year of data available for the 5% Sample and was used to estimate Medicaid dental coverage, based on 2018 dental benefits in each state. Private dental coverage was calculated using the MCBS responses to questions about whether a beneficiary has dental coverage, and the total with private dental coverage includes community beneficiaries who answered affirmatively. Beneficiaries residing in nursing homes and other facilities were not asked the question in the MCBS, which excluded approximately 792,000 non-Medicare Advantage, non-dual beneficiaries; the Medicare Advantage and dual eligible statistics from the 5% Sample include beneficiaries residing in facilities.

To examine the scope of dental coverage offered by Medicare Advantage plans in greater detail, we reviewed 2019 Medicare Advantage plans with the highest enrollment in 6 large metropolitan counties: San Diego, CA; Harris, TX; Cook County, IL; Miami-Dade, FL; Philadelphia, PA; Charleston, SC; and 2 rural counties: Jefferson, OR and Wayne, OH. For this subanalysis, we selected the 8 counties based on geographical region, differences in population and density, where at least 1,000 people were enrolled in Medicare Advantage plans, and at least 3 firms offered plans. In each of the 8 counties, the 3 largest plans offered were selected, with no more than one plan from a firm. The subanalysis examined a variety of aspects of Medicare Advantage plans including premiums, annual caps, coinsurance/co-pays, covered services, networks, sub-contracting of dental networks, among others. Special Needs Plans and Employer-sponsored Group Waiver Plans were excluded.

NHANES 2013-2016 was used to define edentulism as no permanent tooth present and no dental root fragments present. If the tooth was recorded as not being present, it was marked as edentulous. NHANES 2015-2016 was used to define untreated caries. Untreated caries were defined differently in 2013-2014 and 2015-2016, so only 2015-2016 was used in this analysis. Untreated caries were defined as permanent teeth with a carious surface condition. Only individuals with at least one tooth present were included in the analysis. Decay in the root (i.e., root caries) was not included. In both analyses, third molars and dental implants were excluded.