Medicare Plans’ ‘Free’ Dental, Vision, Hearing Benefits Come at a Cost

By Phil Galewitz, Kaiser Well being Information

Wednesday, October 27, 2021 (Kaiser Information) — When Teresa Nolan Barensfeld turned 65 final 12 months, she shortly selected a personal Medicare Advantage plan to cowl her well being bills.

Barensfeld, a contract editor from Chatham, New York, appreciated that it coated her drugs, whereas her native hospitals and her major care physician had been within the plan’s community. It additionally had a modest $31 month-to-month premium.

She stated it was a bonus that the plan included dental, listening to and imaginative and prescient advantages, which conventional Medicare doesn’t.

However Barensfeld, who works as a replica editor, missed a number of the vital effective print about her plan. It covers a most of $500 yearly for care from out-of-network dentists, together with her longtime supplier. Meaning getting one crown or tending to a few cavities may go away her footing many of the invoice. She was circumspect in regards to the cap on dental protection, saying, “I don’t anticipate that a lot for a $31 plan.”

By tv, social media, newspapers and mailings, tens of thousands and thousands of Medicare beneficiaries are being inundated this month — as they’re every autumn through the open enrollment interval — by advertising from Medicare Benefit plans touting low prices and advantages not discovered with conventional Medicare. Dental, imaginative and prescient and listening to protection are among the many most marketed advantages.

These companies are additionally on the middle of heated negotiations on Capitol Hill amongst Democrats as they search to increase quite a lot of social applications. Progressives, led by Sen. Bernie Sanders (I-Vt.), are urgent so as to add dental, imaginative and prescient and listening to advantages to conventional Medicare.

Regardless of the high-powered promoting of the Medicare Benefit plans pitched by the likes of celebrities Joe Namath and Jimmie Walker, beneficiaries nonetheless usually find yourself with important out-of-pocket prices for a lot of of those companies, a latest examine by KFF discovered. That’s partly as a result of the non-public plans restrict advantages. Whereas individuals in conventional Medicare paid on common about $992 for dental care in 2018, these in Medicare Benefit plans paid $766, based on the examine. For imaginative and prescient, individuals with conventional Medicare paid $242, in contrast with $194 for these coated by a Medicare Benefit plan.

“It stands to purpose there can be decrease out-of-pocket spending in Medicare Benefit than in conventional Medicare, however the variations are usually not as giant as one would possibly anticipate,” stated Tricia Neuman, a senior vp at KFF and government director of its Medicare coverage program.

Greater than 26 million individuals had been enrolled in Medicare Benefit plans for this 12 months — 42% of all Medicare beneficiaries. Enrollment within the non-public plans has doubled since 2012 and tripled since 2007. In contrast to conventional Medicare, these non-public plans usually permit protection via a restricted community of docs, hospitals and pharmacies.

Open enrollment for 2022 plans runs from Oct. 15 to Dec. 7, and a few Benefit plans provide enticements comparable to tons of of {dollars}’ price of groceries, home-delivered meals or $1,000 in over-the-counter objects comparable to adhesive bandages and aspirin.

However many seniors don’t understand there are restrictions on these advantages. They might cowl extras just for enrollees with sure well being circumstances or have a slender community of suppliers or annual greenback limits, usually round $100 for imaginative and prescient or $1,300 for dental.

“All these additional advantages encourage individuals to enroll, however individuals don’t know what they’ve till they attempt to use it,” stated Bonnie Burns, a coaching and coverage specialist for California Well being Advocates who helps Medicare beneficiaries consider their well being plan choices.

Seniors sometimes can select from greater than 30 Medicare Benefit plans bought by a number of insurers. The selection is so daunting that fewer than a 3rd of seniors hassle to buy and evaluate through the open enrollment window — regardless that prices and advantages change yearly.

And for many who wish to store round, comparisons are usually not simple. The web site supplies an outline of well being plan prices and advantages and lets seniors evaluate plans’ premiums primarily based on what drugs the beneficiary makes use of. Nevertheless it doesn’t provide a comparability of which docs, dentists or hospitals are within the Medicare Benefit community or present particulars about limits on dental, listening to and imaginative and prescient care. For that data, shoppers should go to every insurer’s web site and skim via a abstract of advantages that may be dozens of pages lengthy.

Mary Beth Donahue, CEO of the Higher Medicare Alliance, a analysis and commerce group representing Medicare Benefit plans, sees issues in another way. “Medicare Benefit’s versatile profit design implies that beneficiaries can select a plan tailor-made to their wants — whether or not which means extra strong protection, or extra fundamental protection, doubtlessly for a decrease price,” she stated.

Casey Schwarz, senior counsel for training and federal coverage on the Medicare Rights Middle in New York, an advocacy group for seniors, stated the additional advantages provided by plans have elevated confusion amongst beneficiaries. These advantages come at a value.

“There may be virtually at all times a trade-off comparable to narrower supplier networks, tighter drug formulary or restrictions in different areas,” she stated.

Jenny Chumbley Hogue, an insurance coverage dealer close to Dallas and an analyst at, which helps seniors navigate this system, stated advertising misleads a few of her shoppers. “They see a TV advert that claims they will get every little thing without cost when they could not qualify for these advantages,” she stated. “It’s onerous to know if they’re misinformed or not studying the effective print.”

She added that buyers ought to select a plan primarily based on whether or not their physician is in that community or their medication are coated on the lowest price. For instance, whereas most plans provide a listening to help profit, it’s often just for a sure sort of help from a single firm, Chumbley Hogue stated.

“The satan is within the particulars, significantly relating to dental,” she stated. “The protection isn’t sometimes what they’re used to coming from an employer plan.”

Medicare Benefit dental advantages have gotten extra strong, although. Almost 90% of the non-public plans provide dental advantages at no additional price and most provide protection for remedy in addition to cleanings and checkups, based on a report by the consulting agency Milliman. The proportion of plans providing preventive and complete dental has jumped to 71% this 12 months from 48% in 2019.

Plans are also growing advantages in order that they meet Medicare’s requirement to spend a minimum of 85% of enrollees’ premium {dollars} on well being companies, Neuman stated. Plans that don’t attain that threshold can face sanctions, together with not being allowed to enroll new members.

Whereas some shoppers might discover the dental profit alluring, not everybody makes use of the protection. The Medicare plan might not cowl their present dentist, in order that they proceed to pay out-of-pocket, she stated.

Medicare Benefit beneficiaries use their dental advantages much less regularly than individuals with dental protection via their employer, stated Joanne Fontana, a principal with Milliman. “Not everybody buys a plan as a result of it covers dental,” she stated, “and it’s not high of thoughts or they [don’t] suppose to go the dentist yearly.”

KHN (Kaiser Well being Information) is a nationwide newsroom that produces in-depth journalism about well being points. Along with Coverage Evaluation and Polling, KHN is likely one of the three main working applications at KFF (Kaiser Household Basis). KFF is an endowed nonprofit group offering data on well being points to the nation.


This story might be republished without cost (particulars).

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