How can Medicare Advantage better serve seniors?

When people think about seniors and health insurance, they generally think of Medicare. We forget that there are seniors who pay out of pocket or avoid care altogether. Studies show supplemental benefits like dental and vision are frequently the focus for seniors evaluating Medicare Advantage plans.

According to a recent Kaiser Family Foundation report, 48 percent of Medicare beneficiaries in 2022 were enrolled in Medicare Advantage plans, and that is expected to increase to more than 50 percent by 2025. Given my experience and time at DentaQuest, I am in the unique position to demonstrate how dental is a differentiator in plan design and overall health. Part of Sun Life U.S., DentaQuest manages dental and vision benefits for more than 33 million Americans through a nationwide network of providers in all 50 states. Knowing the importance of oral health to overall health, it is imperative we address seniors as a specific population with specific dental needs to ensure holistic health outcomes.

It is 2023, and yet many seniors live with poor oral health and limited access to oral health care. This can lead to issues staying nourished, loneliness hardened by poor self-esteem, and problems communicating. We know the emergency department is where some seniors go when they feel pain, but we also know the emergency department is rarely the right place for helping seniors – or anyone, really – with the underlying issues that cause oral pain.

Seniors are underserved when it comes to dental coverage and lack a seamless experience when they exit their commercial health plans or employer-sponsored coverage and age into Medicare. In fact, many older Americans transitioning from employer-sponsored insurance to Medicare are surprised to find dental coverage is not included with the traditional plan. Therefore, it isn’t surprising to see that more than 90 percent of Medicare Advantage enrollees choose plans with a dental benefit.

Research and experience, and even recent political discourse, demonstrate that oral health is important to seniors but we have a gap in serving that need. Medicare Advantage star scores fell significantly from 2022 to 2023, largely due to CMS’s decision to lift temporary scoring relaxations. Moreover, already enrolled members are choosing to switch plans at rates that have never been higher – while in the past, enrollees switched plans during open enrollment at relatively low rates (around 10 percent or less), new data shows that 17 percent of enrollees were abandoning their plan in favor of another. These trends underscore the importance of satisfaction among seniors and point to key areas of focus.

How will we serve the 80 million seniors expected by 2028? What will seniors expect from their health plans? Who will seniors turn to for help finding care?

So, here’s what’s next for seniors: strategic collaboration to ensure better access and outcomes. The right partnerships can establish effective digital tools, empathetic and human customer service, easier access to care and lower overall costs. We are building for the future, which at DentaQuest means we are constantly evolving to ensure we stay ahead of what’s next.

DentaQuest will continue to prioritize oral health, ‘put the mouth back in the body’, and deliver solutions that will improve the oral and overall health of all.