(Credit: © Pamela Brick | Dreamstime.com)
BOSTON — When choosing Medicare coverage, millions of American seniors face a critical decision: stick with traditional Medicare or switch to a Medicare Advantage plan offered by a private insurer. Medicare Advantage plans heavily promote their extra benefits, particularly coverage for dental, vision, and hearing care that traditional Medicare doesn’t include. However, two new studies reveal these advertised benefits often provide far less protection than many seniors expect.
To understand why this matters, consider that Medicare Advantage plans now cover more than half of all Medicare beneficiaries (about 27 million Americans). These private insurance plans receive substantially more government funding than traditional Medicare, about 22% more per person, adding up to roughly $83 billion in additional taxpayer spending for 2024 alone. The premise behind this extra funding is that private insurers will use it to provide better benefits and care.
But are they delivering on this promise?
‘Increased cost not justified’
The first study, published in JAMA Network Open, examined data from more than 76,000 Medicare beneficiaries between 2017 and 2021. Its most startling finding was that many Medicare Advantage members don’t even know what benefits they have. Only about half of enrollees were aware they had dental or vision coverage through their plans.
“Supplemental benefits are a major draw to Medicare Advantage, but our findings show that people enrolled in Medicare Advantage have no better access to extra services than people in traditional Medicare, and that much of the cost comes out of their own pockets,” said Dr. Lisa Simon, assistant professor in the Division of General and Internal Medicine at Brigham and Women’s Hospital and first author of both studies, in a statement. “Older adults and people with disabilities deserve better from Medicare.”
When researchers looked at actual usage of services, they found Medicare Advantage members weren’t getting more dental, vision, or hearing care than people with traditional Medicare — even though traditional Medicare generally doesn’t cover these services at all. To put this in perspective: If you had two neighbors, one with dental insurance and one without, you’d expect the insured neighbor to visit the dentist more often. But that’s not happening with Medicare Advantage plans.
“Medicare Advantage plans receive more money per beneficiary than traditional Medicare plans, but our findings add to the evidence that this increased cost is not justified,” said first author Dr. Christopher L. Cai, who conducted this work as a resident in the Department of Internal Medicine at Brigham and Women’s Hospital.
Medicare’s dental disadvantage?
The second study, published in JAMA, helps explain why. While nearly 87% of Medicare Advantage plans advertise dental benefits, only 8.4% offer what experts consider comprehensive coverage, the kind of dental insurance many Americans are familiar with from employer-sponsored plans. What makes coverage “comprehensive”? Think of features most people expect from dental insurance:
- No copays for regular cleanings and checkups
- No need to get permission before preventive care
- Coverage for basic procedures like fillings and more complex work like root canals
- Annual coverage of at least $1,500
- Reasonable cost-sharing when you need major work done
While almost all Medicare Advantage plans cover basic preventive care like cleanings, only about one-third offer these services without copays. Many plans require members to get prior authorization — essentially permission from the insurance company — before receiving certain services.
An insurance imbalance
The geographic distribution of comprehensive coverage creates additional barriers. While nearly all seniors (99.7%) live in counties where they can get some level of dental coverage through Medicare Advantage, only two-thirds live in areas where they can find a plan offering comprehensive coverage. That leaves about one-third of seniors — roughly 21 million older Americans — living in counties where no Medicare Advantage plan offers comprehensive dental benefits.
“Our study suggests that many Medicare Advantage beneficiaries may not have access to the dental care they need, even if they are enrolled in a plan that nominally provides them with dental coverage,” explained Simon.
The cost differences between Medicare Advantage and traditional Medicare were surprisingly small. Medicare Advantage members saved about 9% on eyeglasses and dental visits — paying around $206 versus $226 for glasses, and $227 versus $250 for dental visits. That’s a savings of roughly $20 per visit or pair of glasses; not insignificant, but perhaps less than many would expect given the extra government funding these plans receive.
What’s particularly concerning is who tends to enroll in Medicare Advantage plans: more women, people over 75, racial and ethnic minorities, and those with lower incomes and education levels. These groups often have the greatest need for dental, vision, and hearing care but may be least able to afford the out-of-pocket costs that remain even with coverage.
Looking at total spending reveals another striking imbalance. Medicare Advantage plans spent about $3.9 billion annually on supplemental benefits (dental, vision, and hearing combined). Meanwhile, their members paid $9.2 billion out of pocket for these same services. In other words, even with insurance, members were paying more than twice what their plans paid for their care.
Is Medicare Advantage really worth it?
These findings raise serious questions about whether Medicare Advantage plans are using their extra government funding effectively. Instead of paying private insurers more to provide these benefits, would it make more sense to add dental, vision, and hearing coverage to traditional Medicare? Could stricter requirements for what constitutes “comprehensive” coverage help ensure plans provide meaningful benefits?
“Many of the attributes we studied—like how much coinsurance a patient would need to pay or whether procedures like fillings or crowns are covered—are fairly complex and probably pretty overwhelming for consumers to review during open enrollment season,” said Simon. “Regulations could prevent low-quality dental plans from being offered in the first place and ensure that consumers actually know what they’re getting when they pick a Medicare Advantage plan.”
The studies make clear that simply having coverage on paper doesn’t guarantee access to care. As more Americans enroll in Medicare Advantage plans — often attracted by promises of comprehensive benefits — understanding these gaps between marketing and reality becomes increasingly important. The real question isn’t just whether Medicare Advantage plans offer extra benefits, but whether those benefits actually help seniors get the care they need.
Paper Summary
Methodology
The first study, examining Medicare Advantage supplemental benefits, combined data from two major national surveys between 2017-2021. Researchers analyzed responses from 76,557 Medicare beneficiaries through both the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS). To ensure clean data, they excluded individuals with both Medicare and Medicaid coverage, as state-specific Medicaid benefits could skew the results. The researchers tracked service utilization, out-of-pocket costs, insurance payments, benefit awareness, and demographic information to build a comprehensive picture of how supplemental benefits worked in practice.
The dental coverage study took a different approach, examining the actual insurance plans rather than user experiences. Researchers analyzed 6,333 Medicare Advantage plans covering over 27 million beneficiaries across 3,080 counties. They developed specific criteria for “comprehensive” dental coverage based on typical employer-sponsored plans, including features like preventive care without copays, no prior authorization requirements for basic care, coverage for at least two annual cleanings, major procedure coverage, minimum annual coverage of $1,500, and reasonable cost-sharing limits.
Results
The supplemental benefits study revealed a striking disconnect between coverage and awareness, with only about half of Medicare Advantage members knowing they had dental or vision coverage. Despite having these benefits, Medicare Advantage members didn’t receive more dental, vision, or hearing care than traditional Medicare members. While they saved about 9% on eyeglasses and dental visits, the overall financial picture showed members paying $9.2 billion out-of-pocket while plans paid $3.9 billion, with additional private insurers covering $2.8 billion.
The dental coverage analysis painted an equally concerning picture. While 86.6% of plans offered some dental coverage, reaching 94% of Medicare Advantage members, only 8.4% of plans provided comprehensive coverage. This meant just 4.1% of members had access to robust dental benefits. Geographic access proved another challenge, with 66.1% of seniors living in counties offering comprehensive coverage, leaving nearly a third without access to comprehensive dental plans in their area.
Limitations
Both studies faced important limitations that help contextualize their findings. The supplemental benefits study couldn’t account for all possible differences between Medicare Advantage and traditional Medicare members, excluded nursing home residents, and relied heavily on self-reported data. Researchers couldn’t determine if high costs deterred service use or track exact hearing aid expenses. The inability to understand why people chose not to use services, even when available, leaves some questions unanswered.
The dental coverage study encountered different challenges. Without universal agreement on what constitutes “comprehensive” coverage, researchers had to establish their own criteria. They couldn’t analyze actual premium costs or track how often benefits were used. The county-level geographic data limited more detailed analysis of access issues, and researchers couldn’t assess the adequacy of provider networks or quality of care delivered.
Discussion and Takeaways
Together, these studies reveal fundamental issues in how Medicare Advantage plans deliver supplemental benefits. Having coverage on paper doesn’t necessarily translate to better access to care, and the substantial extra government funding isn’t producing significantly better benefits for members. Geographic and demographic disparities create additional barriers to care, suggesting the need for more oversight to ensure meaningful coverage. The findings raise the possibility that expanding traditional Medicare to include these services might prove more efficient than the current approach of paying private insurers to provide them.
Funding and Disclosures
Both studies received support from the Brigham and Women’s Hospital Faculty Career Development Grant. The supplemental benefits study authors reported receiving various fees from healthcare organizations, though none that would significantly impact their findings. The dental coverage study’s lead author disclosed grants from dental organizations and professional associations, but these were unrelated to the research at hand. This transparency in funding and potential conflicts of interest helps establish the credibility of both studies.
Publication Information
These findings reached the public through two prestigious medical journals. The supplemental benefits study, “Use and Costs of Supplemental Benefits in Medicare Advantage, 2017-2021,” appeared in JAMA Network Open on January 14, 2025. The dental coverage analysis, “Availability of Dental Benefits Within Medicare Advantage Plans by Enrollment and County,” was published in JAMA on December 26, 2024. Both underwent rigorous peer review before publication, adding weight to their conclusions about the state of Medicare Advantage supplemental benefits.
