Diagnostic and Preventive Dental Benefits for a Medicare Population: Utilization and Costs in a 5-Year Period

This paper examines the cost of providing dental examinations, cleanings, and x-rays to people ages 65 and older. A Medicare Advantage plan based in Rochester, NY covered certain diagnostic and preventive services for its members from January 2005 through December 2009. Services were reimbursed (or paid directly to dentists) at a fee schedule that approximated Rochester-area averages. The schedule remained constant for three years; it was increased by approximately 10% in the fourth year and by another 5% in the fifth year. Individuals covered ranged from 20,197 in January 2005 to 34,169 in October 2009. Annual benefit costs for those who saw a dentist during the year increased from $136.48 in 2005 to $185.00 in 2009. Utilization was 39.2% in 2005; by 2009 utilization had increased to 51.0%. Of the 46,500 people covered at some time during the five years, 17,541 were covered the entire period. These individuals accounted for 69,392 Examinations and 73,121 Cleanings, among other services. Even though patient out-of-pocket costs were zero or close to zero, claims data show that forty percent of the people who were covered for the entire five year period did not have a single preventive dental visit. Had every person in this cohort visited a dentist twice each year, the five-year benefit cost per person would have been at least $782. The actual average was $358.95 per covered person. Because utilization is much lower than 100%, it will cost less than perhaps thought to provide dental services to people 65 and older.