医疗保险优势牙科福利:美国不到半数的县提供全面覆盖。

Medicare Advantage Dental Benefits: Comprehensive Coverage Available In Fewer Than Half Of US Counties.

作者信息

Simon Lisa, Vujicic Marko, Nasseh Kamyar

机构信息

Lisa Simon (

Marko Vujicic, American Dental Association, Chicago, Illinois.

出版信息

Health Aff (Millwood). 2025 Jun;44(6):693-701. doi: 10.1377/hlthaff.2024.01478.

Abstract

Medicare Advantage (MA) plans may offer dental coverage, a supplemental benefit excluded from traditional Medicare despite the importance of oral health to overall health. This study examined the availability of MA dental coverage by county and the characteristics associated with plan availability in 2023. Using public data collected by the Centers for Medicare and Medicaid Services describing MA supplemental benefits, we found that beneficiaries could choose from an average of 34.9 plans offering a benefit but only 1.7 plans offering a comprehensive dental benefit. Nationally, 39.9 percent of counties offered at least one comprehensive dental plan. Using Poisson regression accounting for county-level characteristics, we found that a larger population, higher MA market penetration, and lower MA insurer concentration had the strongest associations with dental benefit availability. Policy makers should consider quality benchmarks for MA dental plans and further evaluate the appropriate role of these benefits in incentivizing MA plan enrollment.

摘要

医疗保险优势(MA)计划可能提供牙科保险,这是一种补充福利,尽管口腔健康对整体健康很重要,但传统医疗保险并不涵盖此项福利。本研究调查了2023年各县MA牙科保险的可获得性以及与计划可获得性相关的特征。利用医疗保险和医疗补助服务中心收集的描述MA补充福利的公共数据,我们发现受益人平均可以从34.9个提供福利的计划中进行选择,但只有1.7个计划提供全面的牙科福利。在全国范围内,39.9%的县至少提供一项全面的牙科计划。使用考虑县级特征的泊松回归分析,我们发现人口较多、MA市场渗透率较高以及MA保险公司集中度较低与牙科福利可获得性的关联最为紧密。政策制定者应考虑MA牙科计划的质量基准,并进一步评估这些福利在激励MA计划参保方面的适当作用。

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