Service costs and allowable coverage for dental care place insurance provisions under scrutiny by patients. Medicare Advantage plans offering dental coverage can now offset costs by recognizing the benefits of teledentistry for Medicare Advantage policy holders.
In fact, there are three valid reasons to add virtual dental benefits to your Medicare Advantage. We’ll cover those in a moment.
It’s useful for this discussion to understand the essentials of dental care access for Medicare Advantage members.
Scope and usage of care is an issue
It’s generally understood that Medicare doesn’t cover dental services - except in limited circumstances. Even under a Medicare Advantage plan dental benefits can vary and burden users with high out-of-pocket costs for some dental issues.
The US government administration’s healthcare agenda for Fiscal Year 2022 includes medicare expansion for dental care among other care protocols (e.g., vision and hearing).
For context - related data is ongoing but thus far includes some “key findings” specific to those enrolled in Medicare Advantage.
- ”In 2021, 94% of Medicare Advantage enrollees in individual plans (plans open for general enrollment), or 16.6 million enrollees, are in a plan that offers access to some dental coverage. Among these Medicare Advantage enrollees: Most (86%) of these enrollees are offered both preventive and more extensive dental benefits.
- More than three in four (78%) Medicare Advantage enrollees offered more extensive coverage are in plans with annual dollar limits on dental coverage, with an average limit of $1,300 in 2021; more than half (59%) of these enrollees are in a plan with a maximum dental benefit of $1,000 or less.
- Nearly two-thirds of enrollees (64%) with access to preventive benefits, such as oral exams, cleanings, and/or x-rays, pay no cost sharing for these services, though their coverage is typically subject to an annual dollar cap.
- The most common coinsurance for more extensive dental services, such as fillings, extractions, and root canals, is 50%. About 10% of Medicare Advantage beneficiaries are required to pay a separate premium to access any dental benefits.” [1]
Don’t get lost in-the-weeds of those “findings.” The better application is to focus on the positive association of Medicare Advantage with dental care access.
And that brings us to its further allowance for innovative care solutions such as virtual dental care via teledentistry.
The top 3 reasons to add virtual dental care benefits to your Medicare Advantage plan
1-Reduce emergency room (ER) visits for dental related conditions
Some dental issues elevate to a point that a trip to the ER seems the only viable option. And in some cases that’s cause for doing so.
Other circumstances might prove otherwise when a virtual care solution, such as teledentistry, is available and covered by insurance.
”Dental care ranks among the most frequently avoidable emergency room visits, with teledentistry providing a resource that may help plan participants make more informed decisions about where to go for care.” [2]
The key is having another option. And one that in the majority of cases could save a patient’s time and costs.
Here’s a comparison.
First, without a virtual dental option:
- Average cost per ER visit - $600 to $800
- Majority of patients return to the ER within 15 days [3]
- Patients are often referred to a dentist because their condition cannot be adequately treated at the ER
And here’s what a patient could expect with a virtual dental option:
- 24/7 access to virtual dental care
- Prescriptions, a care consult, or a referral to an in-network provider
- Referral tracking and follow-up to determine if in-person dental visits are completed
A goal is to avoid more complicated and costly dental treatment. Or a hospital stay that could have been avoided with an earlier care consult or referral.
This brings us to a second virtual dental care benefit for a Medicare Advantage plan.
2-Avoid in-patient hospital admissions for chronic dental conditions
A virtual dental consultation adds a welcome layer of convenience. Access to dental expertise via teledentistry can help patients identify and diagnose conditions that are approaching or are already in a chronic state.
Keep in mind the the average cost per hospital admission is $9,900. [4]
Virtual dental care platforms are:
- Secure
- Provide seamless, real-time collaboration with providers and specialists
- Facilitate referrals to in-network specialists
- Accommodate forms, health records, and other treatment data within the virtual platform
The cost and time savings are a plus for patients who might otherwise avoid dental visits. Thus, putting them at risk unless they have a viable care option.
This makes virtual care a compelling alternative when it’s available as a network benefit.
3-Attract new members with the added/extra benefits provided by virtual care
This is a major appeal for those providing Medicare Advantage plans. Remember that 47% of Medicare beneficiaries do not have dental coverage. [5]
On the upside - 78% of patients report that they would likely use teledentistry over the next few years and beyond if the option was available to them.
That’s a substantial opportunity to set your Medicare Advantage plan apart from the competition.
Again, the goal is helping patients get the dental care they need. And making access to care an easier and cost-effective option in place of more costly care environments.
Explore the following resources that highlight the relevance and benefits of virtual dental care:
Patient Triage and Emergency Care Are Much Different When Teledentistry is Integrated
How Teledentistry Can Improve Payer Network Relationships with Providers and Patients
Why Teledentistry is a Here-to-Stay as a Sustainable Service
A secure, dedicated teledentistry platform that expands care access
Teledentix is an innovative, turn-key teledentistry solution created by Virtual Dental Care. The all-in-one platform will enable you to adapt teledentistry to your patient care and extend your services beyond the walls of your dental practice…and improve your patient care in the process.
LEARN MORE about the Teledentix platform.
[1] https://www.kff.org/medicare/issue-brief/medicare-and-dental-coverage-a-closer-look/
[2] https://www.unitedhealthgroup.com/newsroom/2020/2020-06-24-uhc-dental-teledentistry.html
[3] https://www.mdac.us/file_download/inline/57cb39db-b4f4-4cdb-8829-f062e74fe36c
[4] https://www.mdac.us/file_download/inline/57cb39db-b4f4-4cdb-8829-f062e74fe36c
[5] https://www.mdac.us/file_download/inline/57cb39db-b4f4-4cdb-8829-f062e74fe36c
