Medicare and Dental Coverage: A Closer Look
Methodology
This analysis uses data from multiple sources: Medicare Current Beneficiary Survey (MCBS), 2018 and 2019; Medicare Chronic Conditions Data Warehouse data from 20 percent of beneficiaries (20% Sample), 2019; and CMS Medicare Advantage Enrollment and Benefit files, 2019 and 2021. The analysis also uses data from the Center for Health Care Strategies’ (CHCS) Medicaid Adult Benefits data, updated September 2019.
To determine dental coverage in Figure 1, we combined data from multiple sources. The 20% Sample and Medicare Advantage Benefits files, 2019 were used to determine the number of Medicare Advantage enrollees with access to dental coverage. The 20% Sample, combined with data from CHCS 2019, was used to calculate the number of full dual eligible beneficiaries with some dental coverage based on whether they lived in a state that offered adult dental benefits through Medicaid. While we use CHCS data for dental coverage for adults, it is possible that not all duals are covered by adult dental benefits because the benefit may vary based on eligibility pathway. Private dental coverage was calculated using the share of MCBS 2019 responses to questions about whether a beneficiary has dental coverage, and then using that share to calculate a comparable number of people with private dental coverage using the 20% Sample for estimates of all Medicare beneficiaries. The populations are those with both Parts A and B in March of 2019, excluding the US territories. Had we included those with Part A-only, which is primarily people who have employer-based coverage or some public retirees, the number and share with private dental coverage would be higher.
This analysis of Medicare dental coverage differs from KFF’s analysis of dental coverage in 2016 in several ways, and therefore this data cannot be trended using our 2016 estimate. CMS identified a data collection and processing issue in the Medicare Current Beneficiary Survey 2016 data that resulted in lower estimates of private dental coverage than should have been reported based on actual survey responses. CMS resolved this issue in the 2017 MCBS. In our prior analysis, full dual eligible beneficiaries who lived in states with adult emergency-only dental coverage were considered to have dental coverage. However, in this analysis, they are not considered to have dental coverage because emergency-only coverage does not compare to most coverage provided under Medicare Advantage or private plans; Medicare also provides some emergency-only coverage. There were 16 states that we codified as not providing dental coverage to adults on Medicaid based on CHCS data: AL, TN, MD (no coverage); AK, AZ, FL, GA, ME, MS, NV, OK, TX, UT, WV (emergency-only coverage); and NH, DE (dental benefit was under development in 2019). We excluded from the total 4.4 million Medicare Advantage enrollees who are in employer-group health plans from this analysis (but not in the prior analysis) because information describing supplemental benefits, including dental coverage, are not available. Finally, in our prior analysis, we combined estimates from the 20% Sample and MCBS to determine the total number of Medicare beneficiaries in 2016, whereas the 2019 total population is derived from the 20% Sample.
The 2018 MCBS Cost Supplement file was also used to look at visits to the dentist, and out-of-pocket costs for dental services. MCBS Cost Supplement data from 2019 are not yet available for these variables.
The Medicare Advantage Enrollment and Benefit files for 2021 were used to look at dental coverage for beneficiaries enrolled in individual Medicare Advantage plans (e.g. excludes Special Needs Plans and employer-group health plans). This analysis includes enrollees in Puerto Rico and other territories. Plans with enrollment of 10 or fewer people were also excluded because we are unable to obtain accurate enrollment numbers.
To supplement the Medicare Advantage analysis, we examined the scope of dental coverage offered by ten Medicare Advantage plans in greater detail. We reviewed 2021 Medicare Advantage plans with the highest enrollment, and among these highest enrollment plans, we selected 10 geographically dispersed plans, taking into account variations across firms and a mix of HMO and PPO plans. As part of this illustrative analysis, we examined a variety of aspects of Medicare Advantage plans including premiums, annual caps, coinsurance/copayments, covered services, and networks, among others.
The Healthcare.gov 2021 QHP landscape data was used to look at plans available on the ACA Marketplace. This data only includes dental information from the federal marketplace; states that have their own marketplaces are not represented in this data. Child-only plans were excluded. Data used in this analysis was not enrollment-weighted.