What if Medicare Paid Your Dentist?

Two out of three U.S. retirees do not have dental insurance. Their basic choice is paying their dentist bills directly or, if they can’t afford it, forgoing care.

A new report analyzes the pros and cons of one potential solution to this pervasive problem: adding dental coverage to Medicare. Several bills that have circulated in Congress, including the Seniors Have Eyes, Ears, and Teeth Act of 2019, would do just that.

This approach recognizes that teeth and gums have everything to do with one’s health, said Meredith Freed, a policy analyst for the Kaiser Family Foundation’s Medicare policy program. Elderly people with loose or missing teeth have difficulty eating nutritious but hard-to-chew foods. Gum disease, left untreated, increases the risk of cardiovascular disease, and diabetes, which is increasingly prevalent, makes people far more prone to gum disease.

Oral health care “has a significant impact on people’s happiness and financial well-being,” Freed said. Dental coverage under Medicare would “improve their quality of life.”

But a proposal to do this would face an uphill climb in Congress. Medicare is already under-funded. Dental care would only add to the program’s rising costs. Retirees do have another option: about two-thirds of the Medicare Advantage plans sold by insurance companies offer dental benefits.

Freed’s new report laid out three basic options for reforming Medicare to cover trips to the dentist.

The first would add it to Medicare Part B covering outpatient medical care. The second option would be a separate, Part D-style dental insurance plan. The third option would be to expand the definition of medically necessary dental procedures, which are very limited under current law.

Each has its advantages and disadvantages, Freed said. Grafting dental coverage on to Medicare Part B would extend coverage to the largest numbers of retirees. The services Congress might agree to cover could range from only cleanings to comprehensive care that includes crowns, dentures and implants, and various options for paying out-of-pocket costs include copayments or even the donut-hole method used in Part D plans. The downside of this strategy is that Medicare premiums would increase for everyone who chooses to enroll in Part B. However, the federal government could regulate dentist’s fees to control costs, just as it currently does for physicians’ fees under Part B.

A second option would establish a separate, optional dental plan similar to the Part D drug plan. A big advantage is that retirees could choose the level of coverage they need – people with few dental problems could buy less insurance. But a Part D-style plan would be likely to cover a smaller population than adding dental care to Part B, which more retirees choose. Another problem is that if private insurers offer plans with myriad costs and coverage levels, it would add yet another layer of decision-making for Medicare beneficiaries already facing numerous choices.

The most expedient solution is to expand the number of dental procedures Medicare covers as medically necessary. Only extreme cases are allowed under the current law, such as procedures required prior to a heart valve repair. Under this reform, a limited number of retirees would gain coverage.

It’s clear that retirees need dental coverage. Providing affordable coverage is the challenge.

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