JustCare

Tag: Dental

  • Medicare Advantage dental, vision and hearing benefits offer little value

    Medicare Advantage dental, vision and hearing benefits offer little value

     

    Medicare Advantage plans advertise their “extra” benefits as a way to lure in new enrollees. But, new research published in JAMA Network finds that Medicare Advantage dental, vision and hearing benefits offer little value to enrollees. Enrollees have no better access to dental, vision and hearing benefits than people in traditional Medicare.

    The most recent MedPAC data show that the federal government is spending 22 percent more per Medicare Advantage enrollee than for enrollees in traditional Medicare. The data are increasingly also showing that, notwithstanding the estimated $83 billion more the insurers offering Medicare Advantage received from the federal government in 2024, Medicare Advantage enrollees get fewer benefits than people in traditional Medicare.

    For the most part, insurers offering Medicare Advantage only cover care for their enrollees from a restricted network of physicians and hospitals. In rural communities, people have to travel long distances to see a doctor or get treated at a hospital because their local providers are not in their Medicare Advantage plan network. And, the specialists qualified to treat certain conditions are also often not in-network.

    Moreover, Medicare Advantage insurers often inappropriately delay and deny care to their enrollees, particularly when they have complex and costly conditions. The insurers’ financial incentive is to withhold care because the government pays them upfront regardless of the amount of money they spend on care. The less care they cover the more money they get to keep.

    A team at Mass General Brigham looked at whether the “extra” benefits Medicare Advantage insurers offer add value. Insurers misleadingly claim that they give their enrollees more than traditional Medicare in the form of extra benefits. But, that is not true in fact.

    Insurers often deny Medicare Advantage enrollees coverage for treatments that traditional Medicare covers. And, while insurers technically offer enrollees additional benefits, too often, enrollees are not aware of these benefits or the out-of-pocket costs present a barrier to care. The researchers found that fewer than six in ten enrollees knew their Medicare Advantage plan covered these “extra” benefits.

    Between 2017 and 2021, people in traditional Medicare and Medicare Advantage spent about the same amount for dental, vision and hearing services, notwithstanding that Medicare Advantage plans claim to offer these benefits and traditional Medicare does not.  They also received about the same number of services. There is no reason to be paying Medicare Advantage insurers more per enrollee than the government spends in traditional Medicare.

    “Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said first author Christopher L. Cai, MD. At best, people in Medicare Advantage are getting a discount of less than 10 percent on vision, hearing and dental treatment. Out-of-pocket costs are high, even with the benefits, and the panel of covered providers is narrow.

    “Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” according to senior author Lisa Simon, MD, DMD, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital. “Older adults and people with disabilities deserve better from Medicare.”

    Here’s more from Just Care:

  • Do you really need a tooth implant?

    Do you really need a tooth implant?

    If your dentist suggests you replace your teeth rather than fix them, get a second opinion. You should avoid getting tooth implants if you can. Not only are they extremely expensive, they are not likely to be a better alternative than crowns and root canals, reports Brett Kelman and Anna Werner for KFF Health News.

    Prosthetic teeth are not likely to function as well as your own teeth. One patient of ClearChoice, which provides people with dental implants, couldn’t chew for two years because the implants were not aligned properly. She needed corrective surgery.

    If you can save your teeth, do so. As a general rule, you should get implants when you have missing teeth or teeth so damaged that they cannot be replaced. Dentists’ primary goal should be to preserve their patients’ teeth.

    According to experts, implants are very costly and can lead to surgical complications. Moreover, they increase the likelihood of people having few ways to treat new problems with their teeth. Dental experts say that they find in most cases that they are asked to give second opinions about dental implants, teeth can be saved.

    No one should think that dental implants will hold up better or longer than your own teeth. Don’t believe the TV and social media ads that suggest otherwise. You have to take care of implants even more than you have to take care of natural teeth. You can get gum and bone infections or bone loss in the area surrounding implants. That can destroy the implant’s efficacy.

    Moreover, too often the implants do not fit well and need replacing. Dentists often have not been trained in how to provide an implant. Training is not required in any state except Oregon. Without training and experience, you can imagine what the results might be. Oral surgeons, periodontists, or prosthodontists have training but usually are not performing the implants.

    Many lawsuits have been filed against the dental implant chains, alleging negligence and malpractice. Private equity firms own a lot of dental implant chains. Their goal is to make money.

    What exactly happens when you get an implant? The dentist screws a metal post into your jaw and then attaches a fake tooth or a crown to it. For patients who have teeth that cannot be saved, dental implants can be a lifesaver.

    The companies that are pushing dental implants–ClearChoice, Aspen Dental, Affordable Care and Dental Care Alliance–refused to speak to a reporter about their implant services.

    Perhaps thanks to the marketing, in 2022, Americans had more than 3.7 million implants.

    Here’s more from Just Care:

  • Voters overwhelmingly support adding dental benefits to Medicare

    Voters overwhelmingly support adding dental benefits to Medicare

    Voters overwhelmingly support adding dental benefits to Medicare, reports BusinessWire. But, will Congress ever do so? Dentists are a big obstacle to receiving dental care as are the costs of dental care, yet the costs of not getting care for your teeth can be brutal.

    In a bipartisan poll, 92 percent of voters support adding a dental benefit to Medicare. And, for good reason. Your oral health can seriously affect your mental and physical health. Without proper dental care, millions of older adults have lost their teeth or struggle from gum disease and then struggle to get proper nutrition.

    Right now and historically, more than 30 million older adults and people with disabilities lack dental coverage.  A lot of the people who have dental coverage can’t use it, either because out-of-pocket costs are still prohibitively high or there are other limitations on their coverage. Although Medicare does not cover routine dental care and most other dental care, Medicare recently began to provide some cancer patients with some dental coverage.

    People often join Medicare Advantage plans because these plans often say they offer dental benefits. But, when you look under the hood, their dental benefits tend to be hollow. As a result, high percentages of people in Medicare Advantage plans have not gone to the dentist in the last year.

    Medicare dental benefits are a top priority for Democrats and Republicans alike. Americans support dental benefits as much as they support abortion rights.

    Congress is well aware of the need for a Medicare dental benefit, but has yet to pass a Medicare dental benefit. Senator Sanders introduced a bill in the Senate to expand Medicare dental benefits and improve them in Medicaid. The bill also gives dental benefits to veterans through the Veterans Administration.

    The dental industry, which does not want to see its rates regulated, opposes a dental benefit. Dentists already have a good supply of patients because there is a huge shortage of dentists in the US, with 58 million Americans living in dental deserts. And, they say they do not want to deal with Medicare’s administrative burdens.

    Increasingly, states are allowing dental therapists to treat cavities and other dental needs without supervision from dentists, as a way to help ensure people get dental care. Dental therapists can provide people with temporary crowns and remove teeth that have decayed. While they do not have as much training as a dentist, they have more training than a dental hygienist.

    Alaska, Arizona, Colorado, Connecticut, Idaho, Maine, Michigan, Minnesota, Nevada, New Mexico, Oregon, Vermont, Washington and, Wisconsin all permit dental therapists to provide certain dental care.

    Hundreds of thousands of Americans travel out of the country for their dental care. Mexico offers dental care at far lower cost than in the US.

    Here’s more from Just Care:

  • Dental crisis in the US: 20 percent of Americans have lost their teeth

    Dental crisis in the US: 20 percent of Americans have lost their teeth

    One in five older adults in the US have lost their teeth. There is a dental care crisis. Jessica Glenza interviews Bernie Sanders for her piece in the Guardian on the need to improve dental care as part of fixing our broken health care system.

    Senator Sanders has introduced a bill in the Senate to expand Medicare dental benefits and improve them in Medicaid. The bill also gives dental benefits to veterans through the Veterans Administration.

    Traditional Medicare does not cover dental care. Medicare Advantage plans sometimes offer limited dental benefits, but they are so limited that people in Medicare Advantage face the same dental issues as people in Traditional Medicare.

    Half of adults in the US have gum disease. Sixty nine million adults have no dental insurance and those who do often have limited coverage. Out-of-pocket costs with insurance are high. Most people can’t afford dental bills that are several thousand dollars.

    Two million Americans went to the hospital because of tooth pain in 2019. Nearly half a million other people went abroad for lower-cost dental care.  Dental care is much less costly in Mexico.

    Having bad teeth can cause serious health issues, including malnutrition. It can be emotionally and psychologically destructive.

    Senator Sanders says that expanding dental coverage in the US is a political winner. The overwhelming majority of Americans support it. He is urging President Biden to include dental benefits in Medicare as part of his re-election platform.

    For his part, President Biden has taken small steps to improve dental coverage in Medicare. For example, some cancer patients with Medicare now have some dental coverage.

    Republicans continue to oppose extra Medicare benefits. They claim they are unaffordable. But, it’s all a question of government priorities. Republicans are happy to approve $900 billion in military spending and tax cuts for the wealthiest Americans.

    The American Dental Association opposes a dental benefit in Medicare. It fears a large administrative burden on dentists.

    Here’s more from Just Care:

  • Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Are lower income individuals enrolling in Medicare Advantage for the wrong reasons, at their peril?

    Medicare Advantage enrollment is up, and people with low incomes and people of color are enrolling in Medicare Advantage at disproportionate rates. A new study published in JAMA by Avni Gupta, BDS, MPH, Diana Silver, PhD, David J. Meyers, PhD; et al. finds that lower income individuals are often drawn into Medicare Advantage because of ads promising vision and dental benefits. The authors consider whether this is a good reason for people to enroll in a particular plan or whether these people are more likely to end up in Medicare Advantage plans that threaten their access to care.

    Many people of color and low income individuals rely on misleading marketing to make their choices, which is highly problematic.

    The worst performing Medicare Advantage plans are largely responsible for tens of thousands of unnecessary deaths a year. But we don’t know which ones they are. The data is not available. People who enroll in a Medicare Advantage plan take a gamble that if they develop a serious condition they will get the care they need.

    The American Hospital Association (AHA) has urged the government to step in to protect people in Medicare Advantage. The AHA explains the harm to patients from prior authorization rules that lead to delays and denials of critical care. So does the HHS Office of the Inspector General. The Centers for Medicare and Medicaid Services, which oversees Medicare Advantage, does not have the resources to conduct adequate oversight and enforcement.

    In this study, the data show that Black Americans were more likely to sign up for MA plans with dental or vision benefits than White Americans. People with incomes no more than twice the federal poverty level also were more likely than higher income individuals to enroll in Medicare Advantage plans with dental benefits.

    It’s not clear from the study whether the MA plans with dental and vision benefits have better or worse health outcomes. As it is, they have on average 43 MA plans to choose from, all differing in ways that are impossible to assess, including with respect to premiums, deductibles and out-of-pocket caps, which are knowable, and with respect to typical out-of-pocket costs, denial and delay rates, and mortality rates, which are not knowable. What is clear is that people who enroll in a Medicare Advantage plan take a big gamble with their health and well-being that they will be able to get the care they need should they develop a complex and costly condition.

    Vision and dental benefits in MA plans tend to come with high out-of-pocket costs and to be restricted. While data is limited, it appears that most people do not end up using these benefits, either their dental and vision needs are not covered or they can’t find a provider to see them or their costs are unaffordable.

    What will happen to dental and vision benefits when the government addresses overpayments to MA plans? Based on prior research, changes to these benefits are likely to be minimal. One researcher found that with $1,000 less to spend, MA plans increased monthly premiums by $5. There is also a five percent risk that vision or hearing benefits would end.

    What will happen to Medicare if the government does not address overpayments to MA plans? It is not unlikely that Traditional Medicare will wither on the vine and that insurers will take over all of Medicare. Because they cost so much and often delay and deny care inappropriately, more people with Medicare are likely to be unable to afford or get the care they need, endangering their health and well-being.

    If you’re in a Medicare Advantage plan, take advantage of the Medicare Advantage Open Enrollment period, which runs through March 31. If you can, switch to Traditional Medicare if you want to ensure easy access to the care you need.

    Here’s more from Just Care: