Many Medicare Beneficiaries with Dental Insurance Face Financial Barriers to Care

Poor dental health can adversely affect overall health and well-being and increase the risk of developing or worsening chronic conditions like cardiovascular disease. Although regular dental visits may help detect oral disease that can contribute to poor health, the 2024 Commonwealth Fund International Health Policy Survey of Older Adults found that about one of five older adults did not visit the dentist due to costs. People with dental coverage are more likely to visit the dentist, but we do not know the extent to which costs remain a barrier to care even for those with dental coverage.

Traditional Medicare (TM) does not offer dental benefits. Beneficiaries seeking dental coverage may either purchase a separate dental policy or enroll in a Medicare Advantage (MA) plan offering dental care as a supplemental benefit. Some Medicare beneficiaries (i.e., those dually eligible for Medicare and Medicaid) may have dental coverage through Medicaid, albeit the benefit package varies widely across states. Regardless of how coverage is obtained, dental plans often limit the types of services that are covered, have low coverage limits, and include cost-sharing requirements that may prove burdensome for some beneficiaries.

Using data from the Commonwealth Fund 2023 Health Care Affordability Survey, we examined the difficulties that Medicare beneficiaries age 65 and older — including dual-eligible beneficiaries and those in TM or MA — experience accessing dental services. In addition to estimating the proportion of beneficiaries with dental coverage, we examined differences in utilization and perceptions of affordability by type of Medicare coverage (i.e., TM and MA, non-dual-eligible and dual-eligible beneficiaries).

Dual-Eligible Beneficiaries and People Enrolled in Medicare Advantage Most Likely to Have Dental Coverage

The likelihood of having dental coverage is associated with Medicare coverage type. Beneficiaries enrolled in MA are more likely to have dental coverage than those in TM. Overall, approximately 77 percent of beneficiaries in MA reported having dental coverage, compared to 54 percent of beneficiaries in TM. Similarly, the likelihood of having dental coverage also varies by dual-eligibility status, with dual-eligible beneficiaries being more likely to have coverage than their non-dual counterparts. Among those in TM, two-thirds of dual-eligible beneficiaries reported having dental coverage compared to only one-half of non-dual beneficiaries. Among beneficiaries enrolled in MA, 90 percent of those who were dual eligible reported having dental coverage compared to only 76 percent of those who were non-dual eligible.

Among Those with Dental Coverage, Dual-Eligible and MA Beneficiaries Were Less Likely to Have Received Dental Care

Beneficiaries without dental coverage were least likely to have used dental services. Less than two-thirds (61%) of those without coverage reported that they received dental care in the past two years compared to over three-quarters of beneficiaries with coverage. Among beneficiaries with dental coverage, those in MA (77%) were less likely than those in TM (83%) to have received dental care. Dual-eligible beneficiaries in MA and TM were equally likely to have received dental care. Regardless of whether enrolled in MA or in TM, dual-eligible beneficiaries were less likely than their non-dual counterparts to have used dental services.

Many Beneficiaries with Coverage Reported They Had Received Dental Services, but Care Was Difficult to Afford

One-fourth of beneficiaries with coverage and one-third of those without dental coverage reported that while they had received dental care in the prior two-year period, these services were difficult or very difficult to afford. Beneficiaries enrolled in Medicare Advantage and traditional Medicare were equally likely to report difficulty affording needed dental care.

Findings from this analysis show that Medicare beneficiaries age 65 and older without coverage experience greater barriers to receiving dental care than those with coverage. However, coverage alone does not ensure beneficiaries receive needed care or that care is affordable. As findings from the survey show, despite being more likely to have coverage, dual-eligible beneficiaries and those enrolled in MA were less likely than other beneficiaries to have received dental care. Moreover, regardless of the type of Medicare coverage, one-fourth of beneficiaries with dental coverage reported difficulty affording dental services.

This affordability issue could be the result of limited services covered by many dental policies and high out-of-pocket costs. Recently, the Centers for Medicare and Medicaid Services finalized a rule designed to improve access to adult dental services in Affordable Care Act plans. In addition, policymakers have recently proposed legislation that would make dental coverage available to individuals insured under Medicare and adults enrolled in Medicaid. As policymakers debate options for enhancing dental access, they should investigate ways to ensure that out-of-pocket costs do not impose financial hardships or discourage the use of dental care.