Adding dental benefits to Medicare is a solution to finding a problem

The massive government expansion bill that Democrats in Congress are now trying to pass includes provisions that would add new dental benefits to Medicare, the federal medicare program for the elderly.

Still, it could prove unpopular once older people realize that the proposed changes could leave them with worse dental coverage than they currently have.

We have analyzed the numbers and found that millions of seniors already have dental coverage as good, if not better, than that proposed in this bill. In addition, they enjoy better coverage through private Medicare Advantage plans, which seniors can choose as an alternative to traditional government-run health insurance.

It creates new benefits defined by politicians

If the bill passes, starting in 2028, politicians would create, control and define new uniform dental benefits for traditional health insurance. Medicare would cover preventive and screening services, defined as oral examinations, cleanings, x-rays and fluoride treatments, as well as “basic and major” treatments such as extractions, restorations, bridges, crowns, root canals and periodontal treatments.

For preventive services, Medicare would pay 80% of the authorized fee, with beneficiaries paying the remaining 20%. For “basic and major” treatments, Medicare would initially pay 10% of the costs, rising to 50% in 2032 and subsequent years. Registrants would be responsible for the rest.

It threatens the existing dental benefits of the elderly

The benefits Democrats want to add to Medicare are less than what’s already available to seniors through the privately run Medicare Advantage. Seniors can choose to join Medicare Advantage, a program in which private plans, not government politicians, create benefits based on what their registrants ask for.

Today, 27.1 million seniors have chosen to obtain Medicare coverage through private Medicare Advantage plans. The vast majority — 98% (26.6 million) —are enrolled in a Medicare Advantage plan that provides them with dental benefits. (See the table below).

The story continues

Of Medicare Advantage plans that include dental benefits, 82% cover both preventive and major dental care; 16% only cover preventive care; and 2% only cover major care. In addition, 77% of the plans that cover preventive dental care offer coverage without any deductible, coinsurance or co-payment charged to the member.

So for the 26 million seniors who currently have dental coverage through a Medicare Advantage plan, the proposed legislation would essentially provide them with coverage they already have, but with higher out-of-pocket costs.

In addition to offering inferior benefits, the bill could also undermine current Medicare Advantage dental coverage for seniors.

Under the approach proposed by the Democrats, the government would force dentists and dental assistants to accept the payment rates set by Medicare for the treatment of Medicare beneficiaries, which could reduce the number of dentists willing to treat patients with Medicare. Medicare.

Based on what happened when the Medicare program set payment rates for other doctors and health care professions in the past, there is good reason to fear that this approach will discourage some dentists from seeing. Medicare patients. Those most at risk are the elderly who are currently receiving dental benefits through an employer or union pension plan or supplemental plan that they have purchased directly.

It is unclear how government pricing might also affect dentists’ willingness to participate in Medicare Advantage plans and the willingness of those plans to pay dentists more than the rates set by Medicare.

Another risk is that Medicare Advantage insurers react to the passage of the bill by imposing deductibles on registrants, coinsurance or co-payments for dental coverage in several of their plans. This is because, under current law, Medicare Benefit plans are required to offer at least the benefits provided by traditional Medicare, and Medicare payments to Medicare Advantage plans are calculated against traditional Medicare spending.

Adding dental benefits to traditional Medicare along with government pricing would effectively rebase coverage expectations under Medicare Advantage plans. This would open the door to the possibility of Medicare Advantage plans trying to save money by paying dentists less, imposing cost sharing on registrants, or reducing their networks of covered dentists.

And if Congress adopts another idea that congressional liberals like – reducing payments to Medicare Advantage plans – the chances of these changes occurring become considerably greater.

This means that the prospect of older people facing reduced access to dental care and higher out-of-pocket costs, at least in some localities, is a realistic possibility.

Congress should simply reject these provisions.

Private Medicare Advantage insurers have amply demonstrated that they are able and willing to provide quality dental coverage to the elderly with little or no out-of-pocket costs for preventive care, and good financial protections against the costs of major treatments. . Nor is the right way to improve benefits by micromanaging what works. Instead, Congress should build on existing successes with regulatory reform that gives private plans even more flexibility to continue to design attractive options that seniors want.

As the old saying goes, “If it ain’t broke, don’t fix it.” “

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Original author: Edmund F. Haislmaier

Original location: Adding dental benefits to Medicare is a solution to finding a problem