Dental and vision services for veterans in Medicare Advantage under the microscope

A Research Letter¹ published by Harvard researchers focused on enrollment by veterans who receive benefits from the Department of Veterans Affairs (VA) in Medicare Advantage insurance. While about 10% of veterans enrolled in Medicare Advantage have no Medicare services paid for annually by Medicare Advantage,2 Medicare Advantage receives about $12,000 in capitated payments per enrollee annually,3 raising concerns about duplicative federal spending, according to first author Adam L. Beckman, MD, MBA, and colleagues. He is from Brigham and Women’s Hospital, Department of Medicine, Division of General Internal Medicine, Harvard Medical School, Boston.

Beckman was joined in this research by investigators from the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, both in Boston.

The investigators contend that the use of and spending for these services among veterans enrolled in Medicare Advantage compared with traditional Medicare are poorly understood.

In light of that, they conducted a cross-sectional study with the goal of identifying veterans with VA coverage enrolled in Medicare using the 2018-2021 Medical Expenditure Panel Survey.

The researchers compared the risk-adjusted visits and spending on dental and vision services, and adjusted for age, sex, self-reported race and ethnicity from fixed categories, and chronic conditions that included heart disease, stroke, emphysema, cancer, diabetes, and asthma.

Cross-sectional study results

A total of 468 veterans were enrolled in Medicare Advantage (675 person-years) and 651 veterans enrolled in traditional Medicare (1097 person-years) between 2018 and 2021, representing 1,551,863 and 2,359,268 veteran-years, respectively, after survey weighting. The 2 groups did not differ from each other in age, sex, or race.

The investigators found that both the total number of risk-adjusted dental visits and the total risk-adjusted yearly spending did not differ between veterans enrolled in Medicare Advantage compared with traditional Medicare. However, they did report that although Medicare spending on dental services for Medicare Advantage veterans was $81.8 and $0.1 for traditional Medicare veterans, the veterans in traditional Medicare incurred higher spending through other private insurance. The total annual spending on dental services was similar between the 2 Medicare programs.

Similarly, both the total number of risk-adjusted vision visits and the total risk-adjusted yearly spending did not differ between the 2 programs. The authors found that Medicare spending on vision aids was slightly higher for veterans enrolled in Medicare Advantage compared with the traditional program.

“Although the Medicare Advantage plans offer and directly market supplemental benefits for dental and vision services,^4,5 the veterans enrolled in Medicare Advantage used these services with the same frequency as veterans enrolled in traditional Medicare. Moreover, Medicare Advantage plans spent only modestly more on dental services and vision services for veterans than traditional Medicare, including for emergency dental services. After accounting for private insurance plans used by traditional Medicare enrollees and out-of-pocket spending, the total spending on dental services was no different for veterans in Medicare Advantage vs traditional Medicare. These data are consistent with recent research examining the broader Medicare Advantage and traditional Medicare populations,6” they summarized.

The investigators pointed out that these findings suggested that paying Medicare Advantage plans current annual capitated payment rates to cover veterans whose medical care is primarily paid for by the VA may not be fully justified by supplemental vision and dental care benefits.

“To address this potentially duplicative spending,” they advised, “federal policymakers could reform Medicare Advantage and VA reimbursement to better align with the care veterans receive.”

References:

1. Beckman AL, Dai D, Elani HW, Cai CL, Orav EJ, Figueroa JF. Dental and vision services among veterans in Medicare Advantage vs traditional Medicare. JAMA. 2025;334:538–540. doi:10.1001/jama.2025.7753

2. Ma Y, Phelan J, Jeong KY, et al. Medicare Advantage plans with high numbers of veterans: enrollment, utilization, and potential wasteful spending. Health Aff (Millwood). 2024;43:1508-1517. doi:10.1377/hlthaff.2024.00302

3. Ramsay C, Jacobson G, Findlay S, Cicciello A. Medicare Advantage: a policy primer, 2024 update. The Commonwealth Fund. January 31, 2024. Accessed February 24, 2025. https://www.commonwealthfund.org/publications/explainer/2024/jan/medicare-advantage-policy-primer

4. Maremont M, Weaver C, McGinty T. Insurers collected billions from Medicare for Veterans who cost them almost nothing. Wall Street Journal. December 2, 2024. Accessed February 24, 2025. https://www.wsj.com/health/healthcare/veterans-medicare-insurers-collect-billions-bfd47d27

5. Dorneo A, Ma Y, Garrido MM, et al. Characteristics and benefit design of veteran Medicare Advantage Affinity plans. JAMA Health Forum. 2025;6:e250159-e250159. doi:10.1001/jamahealthforum.2025.0159

6. Simon L, Cai C. Dental use and spending in Medicare Advantage and traditional Medicare, 2010-2021. JAMA Netw Open. 2024;7:e240401-e240401. doi:10.1001/jamanetworkopen.2024.0401