ADA urges CMS to improve supplemental dental benefit oversight in Medicare Advantage

ADA calls for transparency and protections with Medicare Advantage plans

The American Dental Association has urged the Centers for Medicare & Medicaid Services to strengthen protections for Medicare Advantage beneficiaries, including greater oversight of supplemental dental benefits, improvements in marketing practices for these supplemental dental benefits, and the inclusion of all forms of supplemental dental coverage in medical loss ratio calculations. 

The Association submitted comments on the Centers for Medicare & Medicaid Services’ proposed rule, “Contract Year 2026 Policy and Technical Changes to the Medicare Advantage and Medicaid Programs,” which addresses critical areas impacting Medicare Advantage, including network adequacy, marketing standards and supplemental benefits. 

In a letter to Jeff Wu, CMS acting administrator, the ADA provided its perspective on specific provisions that intersect with oral health care and patient outcomes. One of the concerns highlighted by the Association was that plans only allow dentists to participate in the appeal of a claim denial under a supplemental benefit if they sign a waiver of liability agreement. The ADA urged CMS to provide guidance to Medicare Advantage plans that waivers of liability should not be used with supplemental dental benefits, as they discourage provider participation and interfere with the dentist-patient relationship. 

The ADA expressed support for CMS’ proposal to require Medicare Advantage directory data to be integrated into the Medicare plan finder in a standardized format but recommended expanding the proposal to include Medicare Advantage plans offering supplemental benefits. Some of the suggested benefits include dental, vision and hearing services in requirements related to maintaining accurate provider directories. 
 
The Association commended CMS for its proposal to expand the definition of marketing under Medicare Advantage and Part D programs, “which ultimately strengthens oversight of communications materials and mitigates misleading or confusing advertising practices.” The change would require a broader array of materials to be submitted for CMS review and is a vital step toward protecting beneficiaries and promoting transparency in the Medicare Advantage market, according to the ADA.  

In its letter, ADA recommended “that marketing materials that mention specific supplemental benefits, such as dental or vision, include a standardized summary of these specific benefits available under a plan. These standardized summaries should include information such as limitations or exclusions on services, waiting periods, alternate benefit provisions, annual maximums, coinsurance, copays, deductibles and out of network benefits.” 

Additionally, the Association expressed support for CMS’ efforts to codify existing guidance and introduce new protections for the administration of supplemental benefits through plan-furnished debit cards. The ADA also expressed its opposition to processing fees with the increased use of debit cards for Medicare Advantage supplemental benefits. It recommended that CMS work with the Association and dental industry “to develop clear guidance regarding claim filing requirements, real-time benefit verification as well as real-time claims processing both in situations where a debit card is used to administer the benefit as well as in situations where alternate mechanisms are sought for reimbursement.” 

Regarding medical loss ratio, which measures how much of a health plan’s revenue goes toward patient care versus administrative costs, the ADA emphasized that optional dental benefits often fall outside the core Medicare Advantage plan requirements and are not included in the reported medical loss ratio. 
 
“The ADA strongly supports the inclusion of optional supplemental dental benefits in the [medical loss ratio] calculations, especially as consumers are providing additional premium dollars for dental coverage that should go towards their care,” the letter said. “The ADA also encourages CMS to carefully consider the unique characteristics of dental benefits in Medicare Advantage plans when it is included in medical loss ratio calculations.” 

The letter also provided comments on improving experiences for dual eligible enrollees and ensuring equitable access to Medicare Advantage Services, particularly when it comes to artificial intelligence services.
   
“The ADA appreciates the opportunity to provide feedback and commends CMS for its commitment to advancing informed choice and transparency within these critical programs,” the letter concludes. “We urge CMS to carefully consider the ADA’s recommendations, particularly regarding the inclusion of dental benefits in [medical loss ratio] calculations, improving supplemental benefit administration and marketing, and addressing the unique needs of dual-eligible enrollees.”