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

By Phil Galewitz, Kaiser Health News

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

Barensfeld, a contract editor from Chatham, New York, favored that it lined her medicines, whereas her native hospitals and her major care physician have 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.

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

Through tv, social media, newspapers and mailings, tens of thousands and thousands of Medicare beneficiaries are being inundated this month — as they’re every autumn in the course of the open enrollment interval — by advertising from Medicare Advantage 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.

Those providers are additionally on the middle of heated negotiations on Capitol Hill amongst Democrats as they search to broaden plenty of social packages. 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.

Despite the high-powered promoting of the Medicare Advantage plans pitched by the likes of celebrities Joe Namath and Jimmie Walker, beneficiaries nonetheless typically find yourself with important out-of-pocket prices for a lot of of those providers, a latest examine by KFF discovered. That’s partly as a result of the personal plans restrict advantages. While folks in conventional Medicare paid on common about $992 for dental care in 2018, these in Medicare Advantage plans paid $766, in accordance with the examine. For imaginative and prescient, folks with conventional Medicare paid $242, in contrast with $194 for these lined by a Medicare Advantage plan.

“It stands to reason there would be lower out-of-pocket spending in Medicare Advantage than in traditional Medicare, but the differences are not as large as one might expect,” stated Tricia Neuman, a senior vp at KFF and govt director of its Medicare coverage program.

More than 26 million folks have been enrolled in Medicare Advantage plans for this yr — 42% of all Medicare beneficiaries. Enrollment within the personal plans has doubled since 2012 and tripled since 2007. Unlike conventional Medicare, these personal plans typically permit protection by a restricted community of docs, hospitals and pharmacies.

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

But many seniors don’t understand there are restrictions on these advantages. They could 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 extra benefits encourage people to sign up, but people don’t know what they have until they try to use it,” stated Bonnie Burns, a coaching and coverage specialist for California Health Advocates who helps Medicare beneficiaries consider their well being plan choices.

Seniors sometimes can select from greater than 30 Medicare Advantage plans offered by a number of insurers. The alternative is so daunting that fewer than a 3rd of seniors trouble to buy and examine in the course of the open enrollment window — although prices and advantages change yearly.

And for individuals who wish to store round, comparisons are usually not simple. The Medicare.gov web site gives an outline of well being plan prices and advantages and lets seniors examine plans’ premiums based mostly on what medicines the beneficiary makes use of. But it doesn’t provide a comparability of which docs, dentists or hospitals are within the Medicare Advantage 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 browse by a abstract of advantages that may be dozens of pages lengthy.

Mary Beth Donahue, CEO of the Better Medicare Alliance, a analysis and commerce group representing Medicare Advantage plans, sees issues in another way. “Medicare Advantage’s flexible benefit design means that beneficiaries can choose a plan tailored to their needs — whether that means more robust coverage, or more basic coverage, potentially for a lower cost,” she stated.

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

“There is almost always a trade-off such as narrower provider networks, tighter drug formulary or restrictions in other areas,” she stated.

Jenny Chumbley Hogue, an insurance coverage dealer close to Dallas and an analyst at medicareresources.org, which helps seniors navigate this system, stated advertising misleads a few of her purchasers. “They see a TV ad that says they can get everything for free when they may not qualify for those benefits,” she stated. “It’s hard to know if they are misinformed or not reading the fine print.”

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

“The devil is in the details, particularly when it comes to dental,” she stated. “The coverage is not typically what they are used to coming from an employer plan.”

Medicare Advantage dental advantages have gotten extra strong, although. Nearly 90% of the personal plans provide dental advantages at no additional value and most provide protection for therapy in addition to cleanings and checkups, in accordance with a report by the consulting agency Milliman. The proportion of plans providing preventive and complete dental has jumped to 71% this yr from 48% in 2019.

Plans are also rising advantages so that they meet Medicare’s requirement to spend no less than 85% of enrollees’ premium {dollars} on well being providers, Neuman stated. Plans that don’t attain that threshold can face sanctions, together with not being allowed to enroll new members.

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

Medicare Advantage beneficiaries use their dental advantages much less often than folks with dental protection by their employer, stated Joanne Fontana, a principal with Milliman. “Not everyone buys a plan because it covers dental,” she stated, “and it’s not top of mind or they [don’t] think to go the dentist every year.”

KHN (Kaiser Health News) is a nationwide newsroom that produces in-depth journalism about well being points. Together with Policy Analysis and Polling, KHN is without doubt one of the three main working packages at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit group offering data on well being points to the nation.

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