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Medicare Advantage Dental – Does the Future Look Like the Past?

Medicare Advantage (MA)—an alternative to traditional Medicare which allows seniors to receive Part A and B benefits through private insurance—is more popular than ever. As of 2019, over one-third of all Medicare beneficiaries are enrolled in an MA plan and that proportion is expected to reach almost 50% by the end of this decade. To retain and expand membership in an increasingly competitive environment, Medicare Advantage Organizations (MAOs) will need to support whole-body care for their senior population. Offering effective, and sometimes targeted, supplemental benefits supports holistic care and elevates the member experience.

As HealthScape highlighted in a recent Executive Brief, offering competitive supplemental dental benefits can help increase membership and improve health outcomes. We analyzed the MA supplemental dental benefit market data from 2016 to 2020 to synthesize insights and recommendations for MAOs to leverage in forward-looking strategic planning.

Our analysis in this brief is powered by the HealthScape Medicare Advantage Dental Benchmarking product. This product synthesizes five years of CMS dental data and enables plans to analyze dental-specific benefits across service areas, time periods and competitors.

NATIONAL OVERVIEW

While health plans have long-heard the importance of offering supplemental dental benefits, HealthScape’s analysis for this brief focuses on specific benefit line items (e.g., oral exams, extractions) to truly evaluate the importance of targeted supplemental dental coverage. Figure 1, which shows the growing magnitude of average total supplemental dental benefits by county, reveals not only increased access to dental benefits between 2016 and 2020 (as represented by the greater number of shaded counties), but more importantly, the increased richness of dental benefits offered (shown by the greater number of darker shaded counties). MAOs have the option to offer up to eleven different specific benefit line items between preventive and comprehensive services for their supplemental dental coverage. MAOs that continue to offer richer benefits are well-positioned to attract membership and improve member health status.

Notes: Average Total Benefit Count represents a simple average of the number of mandatory comprehensive and preventive dental benefits offered by plans present in each county. For example, in Illinois’ Cook County, there are 57 plans offering a combined total of 382 mandatory benefit service categories across all plans. This averages to 6.7 mandatory total benefits across the county. Note that Optional Supplemental Benefits are excluded as those provide access to benefits not coverage and the total uptake rate can vary.

PREVENTIVE DENTAL BENEFITS OVERVIEW

Preventive dental benefits—dental x-rays, fluoride, oral exams and prophylaxis (cleaning)—are routinely administered services used to lower the risk of more serious dental issues. MAOs have offered these benefits to a large majority of MA members since 2016 to mitigate long-term dental issues. Nevertheless, Figure 2 demonstrates the continued growth and popularity of these benefits in the last five years. As overall MA enrollment increased by over 5 million beneficiaries, the number of individuals without access to preventive dental benefits reduced by about 50% in the same time period.

Figure 3 MAOs offering preventive dental benefits outperform plans that do not. For example, in 2019 the 81% of MAO plans providing preventive services accounted for 83% of enrollment; in 2020, the 86% of MAO plans providing preventive services constitute 91% of enrollment. In addition, it is important to note the growing number of MAO plans year-over-year. From nationally-branded health plans (e.g., UnitedHealthcare, Humana) and Blue Cross Blue Shield Association plans to industry start-ups (e.g., Oscar and Bright) and provider-sponsored organizations, MAOs recognize consistent MA growth and want to gain market-share before it is too late.

BENEFIT HIGHLIGHT: FLUORIDE

Of the four supplemental preventive benefits, Fluoride Treatments have traditionally been offered the least by MAOs, likely because of their association with children rather than seniors. However, even this benefit has seen a major uptick in the last two years. For the first time in 2020, over half of all MA beneficiaries have access to Fluoride Treatments through the combination of MSBs (Mandatory Supplemental Benefits that a beneficiary automatically receives with his or her plan) and OSBs (Optional Supplemental Benefits that can be purchased for an additional fee during enrollment). MAOs should offer Fluoride Treatments to (1) decrease the risk of tooth decay for their senior members and (2) position them as competitive differentiators.

COMPREHENSIVE DENTAL BENEFITS OVERVIEW

Comprehensive dental benefits, which include diagnostic services, endodontics, extractions, non-routine services, periodontics, prosthodontics and restorative services, are usually services provided to treat oral conditions such as damaged or missing teeth. Figure 5 indicates that as recently as 2016, MA beneficiaries were about as equally likely to have some level of comprehensive services covered as they were to not have them covered while in 2020, over three-quarters of beneficiaries have either MSB or OSB comprehensive dental coverage.. In the past five years, those members with comprehensive coverage has nearly doubled from 7.6 million to 15 million members.

Similar to the preventive benefit landscape, Figure 6 shows that MAOs with comprehensive coverage beat their competitors that do not—the 74% of MAOs with comprehensive coverage in 2020 represent 77% of total MA enrollment. This pattern has held each year in the last five years.

BENEFIT HIGHLIGHT: RESTORATIVE SERVICES

Perhaps most representative of the increasing popularity of supplemental comprehensive dental benefits is the correlated surge of MAOs offering Restorative Services as a covered benefit. Between 2016 and 2020, the proportion of members with MSB coverage has nearly doubled from 31% to 60%. Nearly every comprehensive benefit has seen similar consistent growth year-over-year resulting in large jumps.

For MAOs looking to differentiate and offer a high-value supplemental benefit, providing Restorative Services can act as a catch-all benefit that covers repairs related to endodontics, prosthodontics and others.

BENEFIT HIGHLIGHT: PERIODONTICS

One comprehensive benefit, Periodontics, experienced a unique enrollment decrease in 2018 after experiencing consistent growth from 2016- 2017. The dip in 2018 can be attributed to changes by two national MAOs in their ratio of products offering MSB Periodontics versus not offering it. This underscores the dramatic influence the largest MAOs can have on macro-level data. Market-level analytics are necessary to fully understand the competitive landscape and whether an MAO should offer Periodontics, as well as other benefits, to its members.

FUTURE PERSPECTIVE

New 2021 MA plans became available for purchase on October 15, 2020, for the Annual Enrollment Period (AEP). While seniors should compare products in their service area to find the best plan for them, MAOs should evaluate their offerings against competitors to see how their benefits, cost-sharing and enrollment measure up. We recommend MAOs be aware of the following two trends in the supplemental dental benefit market in the future:

HIGHER QUANTITY, HIGHER QUALITY

Recent growth trends will continue as an even greater number of MA beneficiaries will have access to dental benefits. Furthermore, the proportion of those with MSBs will increase relative to OSBs, and the number of average preventive and comprehensive benefits will also grow.

COMPETITION AGAINST OTHER SUPPLEMENTALS

CMS has increased the number and variety of MAO supplemental benefits to encourage competition and improve member health status. In addition to offering standard dental, vision and hearing supplemental benefits, MAOs can now cover unique benefits such as diabetes education programs, nutrition counseling and even cooking classes to improve a member’s diet. Some growth in the dental market may face headwinds by MAOs’ interest in investing in these tailored services to differentiate in a very competitive market.

Notes: HealthScape focused its MA dental benefit analysis on total membership rather than total number of plans offering dental benefits. Highlighting membership over offering plans gives a clearer picture of total coverage. In addition, we assessed both methodologies (i.e., percentage of total membership and offering plans) and determined a similar trend (usually within 2-5% of each other and membership weighted greater than offering plans). The analysis showed the same relationship trend across all benefits.

HEALTHSCAPE CAN HELP.

HealthScape’s dental experience paired with our new Medicare Advantage Dental Benchmarking product can help your MAO understand 2021 market dynamics and prepare for 2022 offerings. View the print option on the upper right-hand side of this page for screenshots of how the product can turn insight into execution. For a demo of the product, please contact Brian Goetsch.

Contact Brian Goetsch for more information.