Medicare to Cover 3 New Dental Procedures

“Is it medically necessary for a person to be able to chew?” Dr. Lisa Simon, a physician and dentist at the Harvard School of Dental Medicine, asks.

This is a serious question for older Americans in fragile health. I know a 93-year-old man whose teeth problems make it extremely difficult for him to eat meat and many other foods on the dinner table.

Two-thirds of retirees do not have dental insurance, which means they may decide to forgo getting expensive dental care. The importance of dental care to nutrition and health is also an equity issue for older Blacks and low-income retirees, who are more likely to be missing all of their teeth.

Medicare has historically paid for very few dental procedures. But the Centers for Medicare and Medicaid Services has expanded its existing, limited coverage to include treating patients who have oral infections prior to an organ transplant and patients who need a cardiac procedure or treatment of head and neck cancers.

Simon, who advocates for integrating dental care into overall medical care, argues in the journal Health Affairs that Medicare’s expansion of coverage for medically necessary procedures does not go far enough.

“These provisions are an overly narrow interpretation of what makes a health care service ‘necessary,’ ” Simon writes.

She lists several examples of medically necessary conditions that don’t seem to fit Medicare’s updated definition. They include cancer patients who have oral inflammation during chemotherapy, diabetes patients with periodontal disease, and elderly women being treated for osteoporosis with injections that put them at risk of painful jaw deterioration.

She is, however, hopeful that the recent expansion of coverage of some complex medical conditions will open the door to broader coverage. The new regulation, she said, will create an “infrastructure to reimburse for dental care” that could be used to eventually expand the procedures Medicare will pay for. But several efforts in Congress to add comprehensive dental insurance to Medicare have failed, and a legislative fix seems unlikely in the near future.

The recent regulatory expansion of coverage is “a stopgap measure,” Simon said, based on the faulty assumption “that dental care itself is fundamentally not medical care.”

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