Medicare Advantage and its Impact on Oral Health Equity among Older Adults

项目总结/摘要 尽管对口腔保健的需求很大，但许多老年人依赖传统的按服务收费（FFS） 医疗保险，不提供常规的牙科福利。对口腔保健服务的需求尤其 对少数种族/民族和经济上处于不利地位的老年人至关重要， 这些群体的口腔健康状况明显比他们的同龄人差。Medicare Advantage（MA）健康 美国老年人可以使用FFS Medicare计划作为FFS Medicare健康计划的替代方案。MA计划提供访问 比传统的FFS医疗保险更全面的牙科福利， 背景的人比其他人口统计学特征的人以更高的比率注册MA。因此，MA覆盖范围可能有助于 促进符合医疗保险条件的老年人的口腔健康公平。我们的分析及时， 一项探索性研究将有助于确定在获得和利用口腔保健方面是否确实存在公平性 在所有MA注册者的人口统计数据中提供服务。我们将实现以下目标：目标1。估计 传统上服务不足的群体与他们的同行相比， 医疗保险优势（MA）计划中的牙科保险;如果 覆盖;并且更有可能接受紧急牙科护理和在非牙科诊所接受牙科护理 使用承保牙科服务时的设置;目标2。估计MA牙科覆盖率的差异，MA 受保牙科使用取决于MA牙科保险、紧急牙科护理和牙科类型 在控制社区因素后，以MA覆盖的牙科使用为条件，包括 除其他外：县级措施，在杀戮中渗透MA覆盖面， 按种族/民族和收入划分的MA注册者中MA牙科覆盖率的集中度，以及 牙科供应商的市场供应。研究结果将直接关系到目前的国家一级的政策 决定如何改善医疗保险人群的口腔健康，特别是 弱势群体。

Project Summary/Abstract Despite the great need for oral healthcare access, many older adults rely on traditional fee -for-service (FFS) Medicare, which does not provide routine dental benefits. The need for oral healthcare services is especially critical for older adults who are racial/ethnic minorities and those who are economically-disadvantaged, as these groups display significantly poorer oral health than their counterparts. Medicare Advantage (MA) health plans are available to U.S. seniors as an alternative to FFS Medicare health plans. MA plans offer access to more comprehensive dental benefits than traditional FFS Medicare, and individuals from underserved backgrounds are enrolling in MA at higher rates than other demographics. Therefore, MA coverage could help facilitate oral health equity among the Medicare-eligible older adult population. Our analyses in this timely, exploratory study will help to determine if there is in fact equity in access to and utilization of oral health services among all demographics of MA enrollees. We will conduct the following aims: Aim 1. Estimate whether traditionally underserved groups, compared to their counterparts, are less likely to have dental coverage in their Medicare Advantage (MA) plans; are less likely to use dental services if covered; and are more likely to receive emergency dental care and receive dental care in a non-dental setting if using covered dental services; Aim 2. Estimate disparities in MA dental coverage, MA covered dental use conditional on MA dental coverage, and emergency dental care and type of dental setting conditional on MA covered dental use after controlling for community-level factors, including among others: county-level measures for the penetration of MA coverage among eligibles, the concentration of MA dental coverage among MA enrollees by race/ethnicity and income, and the market supply of dental providers. The study results will be directly relevant to current, national-level policy decisions around how to improve oral health access to the Medicare population, particularly among underserved groups.