Summary: Medicare has always lacked dental services. Some dentists are now offering dental practice “memberships”. But dental health is too important to be handled piecemeal and unregulated. It’s time for dental coverage in Medicare!
Dentists Chip Away at Uninsured Problem by Offering Patients Membership Plans
Kaiser Health News
September 17, 2021
By Phil Galewitz
A quarter of dentists nationwide [offer] memberships, according to a 2021 survey of 70,000 dentists by the American Dental Association.
These in-office plans are largely targeted to the 65 million Americans who lack dental insurance and have to pay out-of-pocket for all their care. Dentists also like the plans better than handling insurance plans because they don’t have to deal with insurers’ heavily discounted reimbursement rates, waits to get preapprovals to provide services and delays in getting their claims paid.
Comment by: Allison K. Hoffman & Hannah Leibson
Congressional Democrats continue to battle over the size and scope of the 2022 budget reconciliation bill. The $3.5 trillion version of the bill proposed in September adds dental, vision, and hearing benefits to the traditional Medicare program. But if the total spending decreases to levels that moderate Democrats like Joe Manchin (WV) and Kyrsten Sinema (AZ) currently demand, these benefits are at risk.
Since Medicare’s passage in 1965, dental coverage has not been part of traditional Medicare benefits, despite strong evidence that poor oral health can exacerbate other health conditions. As noted in an earlier HJM post, without this benefit, approximately 24 million Medicare enrollees lack access to dental coverage. In turn, many do not seek out needed dental care, a problem disproportionately affecting communities of color and low-income beneficiaries. For Medicare beneficiaries who did seek dental care in 2018, average out-of-pocket spending neared almost $1000 a year.
Today’s options for beneficiaries are not great. Some people enroll in Medicare Advantage, which generally includes some dental benefits. Moving into a managed care plan with a private insurer can be unappealing in various other ways, however.
This recent Kaiser Health News article highlights another alternative, one that also falls short. It describes how up to 25 percent of dental practices nationwide have begun to offer independent membership plans to their patients. These prepaid care plans provide, for a fixed monthly fee, access to basic services like an annual exam, coverage for an emergency visit, and discounts on procedures. The yearly cost to enroll in one of these plans is about $300-400.
These plans may chip away at the number of people who forgo needed preventive care, but they are far from a replacement for dental benefits. Someone enrolled in a prepaid plan who needs more than routine care could still face substantial bills for procedures, even with discounted rates. The plans, unlike dental insurance plans, are unregulated, so no one is ensuring they deliver as promised. And, Galewitz reports, the discounts offered on services are typically less than in dental insurance plans. In addition, dental insurance plans negotiate lower rates with dentists, which also reduces patients’ share of the bills.
Dentists who offer these prepaid plans gain confidence that their bills will be paid, and at the rates they want—rather than the ones that dental insurance plans negotiate. But these plans are not a good long-term policy solution for seniors, even if they encourage them to seek out routine dental care. As Galewitz notes, however, many seniors are enrolling in them.
What is tragic is that the American Dental Association (ADA), the largest industry association for dentists and, as the Wall Street Journal describes, “one of Washington’s most powerful health professional organizations,” has urged its members to oppose a broad dental benefit. At its core, the ADA fears Medicare would reimburse dentists less than what many patients currently pay for services. Their opposition is reminiscent of the American Medical Association’s opposition to Medicare’s initial passage, and the ADA’s opposition to including dental benefits in the program from the start. It is not a position that puts patients’ interests first.
On the other hand, the Center for Medicare Advocacy and various others, including the National Dental Association, an organization of minority dentists who promote oral health equity in communities of color, are putting patients’ needs first and have signaled strong support.
This lineup of interests casts a clear message to Senators who care about the health and financial wellbeing of seniors: it is past time for traditional Medicare to include dental benefits.