Medical-Dental Integration in Medicare: Where are We Now?

Figures & data

Table 1. Function of Medicare Parts A, B, C, and D.

Medicare Part	Coverage and limitations
Part A	Inpatient medical care and some rehabilitation services; usually premium-free
Part B	All outpatient clinical visits; requires additional premium
Part C (Medicare Advantage)	Private plans that include all services covered under Parts A, B, and D and may include additional benefits, such as dental care; requires additional premium
Part D	Prescription drug coverage; requires additional premium

Table 2. Common terminology and definitions in discussions about Medicare dental benefits.

Accountable Care Organization	An insurance model in which health systems are provided with risk-adjusted payments to keep individual patients healthy, rather than being paid for each episode of care. Often utilizes validated quality metrics to ensure high-quality care is being provided to patients.
Dual eligibility	Individuals who qualify for both Medicare (due to age or disability) and Medicaid (due to income eligibility).
Fee-for-service	An insurance model in which providers or health systems are paid separately for each service they provide. Incentivizes over-treatment and undervalues preventive services, which are generally lower-cost.
Means Testing	Restricting services or benefits to individuals who meet specific income or wealth benchmarks.
Part D “donut hole”	A gap in Medicare Part D prescription drug coverage, which required Medicare beneficiaries to pay 100% of drug costs when their medication costs exceeded a certain threshold but did not yet reach an even higher limit. This “donut hole” was closed as part of the Affordable Care Act.