Benefit Design and Access to Dental Care Among Seniors With Medicare Advantage Dental Benefits.

Importance: Although Medicare Advantage plans frequently offer dental benefits, enrollees report lower rates of dental care use and higher rates of unmet dental need compared with individuals with employer-sponsored benefits. It is unknown which attributes of Medicare Advantage dental plans are associated with enhanced dental care access.

Objective: To determine attributes of Medicare Advantage dental plans associated with higher rates of dental care use and lower rates of unmet dental need.

Design, Setting, And Participants: This cross-sectional study included respondents from the 2019 Medicare Current Beneficiary Survey whose Medicare Advantage plan identifiers were linked to 2019 Medicare Advantage dental plan data from the Centers for Medicare & Medicaid Services. Respondents enrolled in a Medicare Advantage dental plan for all 12 months in 2019. Data analysis was performed between May and August 2024.

Exposures: Medicare Advantage plans offering dental benefits.

Main Outcomes And Measures: Main outcomes were unmet dental need in the past year, unmet dental need due to cost in the past year, and whether the respondent visited a dentist in the past year. Outcomes were measured in a survey of individuals ages 65 years and older.

Results: In a sample including up to 1789 enrollees (mean [SD] age, 74.7 [7.4] years; 58.4% female; and 13.2% lived in a rural county), enrollees in Medicare Advantage HMO plans were 7.0 percentage points (95% CI, 3.2 to 10.9 percentage points) more likely to report unmet dental need and 4.4 percentage points (95% CI, 0.9 to 7.8 percentage points) more likely to report an unmet dental need due to cost. Prior authorization was associated with an increase of 4.5 percentage points (95% CI, 0.3 to 8.7 percentage points) in unmet dental need. Relative to plans that imposed no out-of-pocket costs on comprehensive services, plans that covered only preventive services were associated with an increase of 12.1 percentage points (95% CI, 3.2 to 21.0 percentage points) in unmet dental need and an increase of 7.8 percentage points (95% CI, 0.6 to 15.0 percentage points) in unmet dental need due to cost. Relative to plans with up to a $500 annual plan maximum, benefits with no annual plan maximum were associated with a decrease of -12.4 percentage points (95% CI, -20.9 to -3.8 percentage points) in unmet dental need.

Conclusions And Relevance: This study found that restrictive characteristics of Medicare Advantage dental plans are associated with greater unmet dental need and financial barriers to care. Results of this study suggest that increasing annual plan maximums or eliminating them entirely from benefit plans could decrease unmet dental need and increase dental care utilization.