2021 Santa Fe Group Updated Plan and Cost Estimates for Medicare Part B Dental Coverage
2021 Santa Fe Group Updated Plan and Cost Estimates for Medicare Part B Dental Coverage
This document updates work published in 2017 by Jones and Monopoli1 which outlines an approach to development of a dental benefit in Medicare. It updates the costs of the 2017 plan for inflation; it modifies the original plan to address the desire of Congress for the dental benefit to be familiar to those seniors who will receive it; it adds a Supplemental Dental Benefit (SDB) for those with certain systemic diseases; and it expands funding for dental coverage for those seniors who already have it through such programs as Medicare Advantage (MA), Medicaid and private insurance. Finally, it provides for a voluntary Expanded Dental Benefit (EDB) with premiums and co-pays.
Medicare currently has an extraordinarily narrow dental benefit, contributing to oral health inequities among seniors. Half (47%) of Medicare beneficiaries did not have dental coverage in 2019. In 2018, the beneficiaries most likely to be without a dental visit included seniors of color, with highest rates among Blacks (68%), Hispanics (61%), low income (73%), or who were in fair or poor self-rated health (63%).2
To correct this healthcare inequity, we propose to expand Medicare Part B to include a Basic Global Dental Benefit (BGDB) and a Supplemental Dental Benefit (SDB) which require neither premiums nor co-pays from the insured. The specifics of the program are listed in the chart below, and the cost for the approximately 34.2 million Medicare enrollees who have no dental coverage is estimated to be $148.4 billion over 10 years. In addition, we estimate the cost for the approximately 31 million who currently have some dental coverage (MA; Medicaid; Private) to be $75.9 billion over 10 years. This cost is substantially lower because Medicare already covers some of the dental costs of these plans, and the additional funds will be used to upgrade the existing MA and Medicaid dental plans to match the BGDB and the SDB. Thus, the total estimated cost for BGDB and SDB would be $224.3 billion over 10 years. The BGDB includes diagnostic, preventive care including cleanings, periodontal scaling and root planing, x-rays, and fluoride treatments (including silver diamine fluoride) at 70% of UCR. The SDB is designed to take advantage of the reduced hospitalization costs by providing up to two additional preventive visits per year for individuals with non-communicable diseases (e.g., heart disease, stroke, diabetes, kidney disease and chronic lung disease) to receive cleanings and scaling and root planing. SDB is projected to pay for itself because diagnostic/preventive services have a significant positive ROI in the prevention of future dental needs, and non-surgical periodontal services have a significant positive ROI on future medical costs.
We also propose to add an Expanded Dental Benefit (EDB) which will require premiums and co-pays consistent with Medicare Part B. The premiums and co-pays in this plan are expected to pay for it using the sliding income scale as currently defined in Part B. The EDB includes crowns, dentures, root canals, and implants (limited by an annual cap of $1,500). We use published data from our original analyses2 updated for inflation. Co-pays were set a 20% to be consistent with Part B; however, if Congress set them at 50% the premiums would be much more competitive.
References
- Jones JA, Monopoli M. Designing a new payment model for oral care in seniors. Compendium 2017; 38 (9): 622-629. PMID: 28972386.
- Freed M, Ochieng N, Sroczynski N, Damico A, Amin K. Medicare and Dental Coverage: A Closer Look. Medicare and Dental Coverage: A Closer Look | KFF. Accessed August 11, 2021.
View 2017 Paper published in Compendium: Designing a New Payment Model for Oral Care in Seniors
