Dental benefits in a Medicare Advantage plan: Utilization during the first two years

Beginning in 2005 Preferred Care Gold, a Medicare Advantage plan based in Rochester, NY, began covering dental examinations, cleaning, and certain x-rays. Enrollment grew from 26,606 individuals 65 and older in January 2005 to 32,393 in December 2006. 24,044 were covered throughout 2005, and 27,296 were covered throughout 2006; 22,272 were covered for the entire period. This study examined utilization patterns by age and gender for each of the two years as well as for the entire two-year period. Data were taken from dental claims. During 2005 42% utilized the benefit; utilization was 45% in 2006. Of the individuals eligible in both 2005 and 2006, fewer than half, 49%, sought dental treatment. Eligible individuals were broken into five age groupings. Utilization increased slightly from 2005 to 2006 for every age/gender cohort. In both years utilization decreased with increasing age. 47% of individuals 65-69 sought dental treatment in 2005 (50% in 2006), while only 28% of individuals 85 and older sought treatment (31% in 2006). During both years females utilized at higher rates than males – except among individuals 85 and older. The dental benefit was initiated in order to promote preventive care by reducing an economic barrier. Dental health is part of the overall health of an individual, and dental examinations are useful in identifying markers for a variety of adverse health conditions. Baseline utilization data developed during this study will be used in the formulation of strategies to increase the percentage of members who seek regular dental treatment.