1. Access Gaps in Dental Procedure Coverage for Medicare Beneficiaries and Dental Coverage Perceptions in Philadelphia J. Zefran1; R. Diecidue, DMD, MD, MBA, MSPH2 1College of Population Health, Jefferson University; 2Department of Oral and Maxillofacial Surgery, Jefferson University
BACKGROUND
METHODS
DISCUSION
Dental coverage through Medicare A and B Medicare beneficiaries is extremely limited.
Beneficiaries may opt to buy private insurance through Medicare Advantage (Part C) to cover healthcare costs not covered in Parts A and B.
According to the Medicare Current Beneficiary Survey, Cost and Use file, Medicare beneficiaries spend 4% of income on dental, hearing and vision.
In 2012, Medicare beneficiaries dental procedures were covered by the following; 75% out of pocket, 12% employer sponsored, 9% other, 4% Medicare Advantage and 1% Medicaid.
In 2016, the average total spending for dental was $927 annually; 22% was covered by insurance and 77% was out of pocket spending.
Dental procedures often have a negative perception and can prevent people from seeking care, along with climbing costs.
Participants:
Patients seen through Jefferson Department of Oral and Maxillofacial Surgery over 65 who have had a procedure performed in the past year. Procedures include, but are not limited to: extractions, excisions, implants and other various surgical procedures.
Quantitative:
100 random charts were selected for a chart review from patients over 65.
Sex, age and payment information was collected.
Qualitative:
A non-random number (9) from the previous 100 charts were asked to participate in a phone survey.
The survey consisted of 7 questions about dental coverage and perception of dental care.
Government funded health programs barely cover the cost for dental procedures, and those covered by Medicare were severe, specific type cases [Medicare 6%, Medical Assistance 21%].
Private insurance through Medicare Advantage was a small fraction and various private dental plans covered a fifth of procedures [Private insurance 20%, Medicare Advantage 9%].
Self-pay is the overwhelming majority payment method, covering half of dental associated costs.
There were also some people who had dental insurance that covered a certain percentage of the procedure and paid the difference out of pocket.
Only 1/3 of the survey participants knew about Medicare Advantage.
Almost 2/3 of the survey participants paid out of pocket for a dental procedure, one person having to pay a few thousand dollars extra since insurance only covered a fraction of the cost.
No person said cost deterred them from having a procedure done.
Most people felt that dental insurance was not important. One participant stated “No we don’t need it. It's (dental) not as serious as medical problems can be. You can work with a broken tooth, you can’t work with a broken arm.”
RESULTS
Survey Questions
1. Do you know about Medicare Advantage (Part C) that covers some dental procedures?
2. Have you ever thought about buying private dental insurance? If so, has the cost of private dental insurance prevented you from buying it?
3. Do you receive Medical Assistance to pay for dental services?
4. Have you paid out of pocket for dental services?
5. Has the cost of a dental procedure prevented you from having it done?
6. Has an oral health problem affected your ability to work or perform every day tasks?
7. How many times have you been to the dentist in the past year?
Age
Sex
F M
Medicare Coverage
F M F M
65-70 35 18 33 17 2 1
71-75 11 10
76-80 6 9
81-85
86-90
91-100
100+
Table 1. Ratio of Medicare Coverage, among sex and age groups.
Age
Medicare
F M
Medicare Advantage
F M
Medical Assistance
F M
Private Insurance
Self
Pay
F M
65-70 2 1 3 7 18 10
71-75 5
76-80 4
81-85
86-90
91-100
100+
CORE COMPETENCIES
A9, A12, B5, B6, B7, C3, D6, E1, E3, E7, F8, G1, G2, H2
ACKNOWLEDGEMENTS
Thank you to Dr. Diecidue and the staff at Jefferson OMFS for their help and the patients that participated in the survey.
Table 2. Ratio of various payment methods.