With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, outlines the need for oral health care coverage for Medicare recipients and the importance of it being integrated with, and elevated to, the same importance as the rest of health care in Medicare.

“Oral health is an essential part of overall health for people of all ages, especially seniors. Adding a dental benefit to Medicare is necessary to achieve health equity for the millions of older adults who rely on Medicare,” said Jennifer Goldberg, Directing Attorney, Justice in Aging

Medicare plays a key role in providing health and financial security for 59 million older people and younger people with disabilities. However, traditional Medicare does not include coverage for routine oral health care like checkups, cleanings and x-rays, or restorative procedures like fillings or crowns, tooth extractions and dentures.

“Including an oral health benefit in Medicare Part B would provide the greatest number of beneficiaries with access to dental care that is desperately needed. It’s also the simplest solution from an administrative standpoint,” said Jennifer Goldberg.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes.

Top findings include:

• 70 percent of all Medicare recipients lack or have limited dental insurance and fewer than half access dental care each year.
• Cost is the number one reason that older adults have not gone to the dentist in the past year.
• Oral pain and tooth loss in older adults can lead to poor nutrition and exacerbate chronic conditions such as diabetes, hypertension and hyperlipidemia.
• Integrating dental coverage in Medicare would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education.
• Surveys show that consumers widely support adding oral health coverage to Medicare and prioritize two categories of care: checkups and pain treatment.
• 71.2 percent of dentists agree that Medicare should include comprehensive dental benefits and a majority indicated they were willing to comply with typical Medicare practice requirements.
• As part of an ongoing investigation of alternatives to serve the dental care needs of a growing elder population, the ADA recently commissioned a study that analyzed the cost structure for various dental benefit designs within Medicare. This study estimated that a comprehensive benefit without dollar value caps would cost the federal government between 31.4 billion dollars in 2016 dollars, $32.3 billion in 2018; the estimated base premium increase for a Part B benefit would be $14.50 per beneficiary per month.

An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care recommends the addition of a comprehensive oral health benefit to Medicare Part B that would operate the same as coverage of other outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services.

Advantages to the inclusion of Part B include:

• Ensures that everyone enrolled in Medicare will receive the oral health benefit.
• Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable access and provider participation.
• Uses established processes and protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.

To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare statute.

The recommendations included in An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care stress the necessity of an oral health benefit for older adults. Read more about the medical necessity, costs, proposed structure and legislative changes needed at oralhealthamerica.org/medicaretoolkit.