How Medicare Benefits Would Change Under Plan Proposed by Doctors

Doctors are pushing for a key Medicare change that would expand coverage to your next dentist appointment.

A group of dentists came together last week to ask Congress to add dental coverage to Medicare. The group pointed out that more current beneficiaries need to visit a dentist each year.

If Medicare included dental coverage, more beneficiaries would be likely to go to the dentist. Improved dental health could save them thousands in out-of-pocket costs each year.

“Fewer than half of Medicare beneficiaries see a dentist each year,” Dr. Lisa Simon, an associate physician at Boston’s Brigham and Women’s Hospital and a faculty member at Harvard Medical School, told Congress. “When they do, they spend more than $1,000 out of pocket on their care.”

Currently, dentistry coverage under Medicare Advantage plans often keeps recipients on private company plans instead of traditional Medicare, which offers no such coverage.

“Dental plans are often a draw for beneficiaries that choose Medicare Advantage,” Simon said. “But my research has found that beneficiaries with Medicare Advantage have rates of dental access that are just as low and out-of-pocket costs that are just as high as traditional Medicare beneficiaries. Medicare Advantage is not the solution here.”

Dr. Myechia Minter-Jordan, president and CEO of Boston’s CareQuest Institute for Oral Health, echoed Simon’s statements. She added that because of Medicare’s current guidelines, around 25 million older Americans and people with disabilities have no dental benefits.

“There is currently no financial support for adults to purchase dental insurance through [the Affordable Care Act’s] Health Insurance Marketplace,” Minter-Jordan said. “And adult dental coverage is optional under state Medicaid programs, which means that coverage varies widely from extensive benefits to none at all.”

For those that go without dental care, cavities and gum disease are common. But there are also larger health problems that can be missed without routine dental visits, including those related to diabetes.

“This would be an overwhelmingly positive development for Medicare recipients if added,” Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, told Newsweek. “There’s a reason why many in the medical community are advocating for the switch: The additional expenses individuals accumulate when visiting the dentist have caused many to avoid seeing one altogether.”

Vermont Senator Bernie Sanders, who chairs the Senate‘s Committee on Health, Education, Labor and Pensions, has pushed for similar programs to expand dental coverage for America’s vulnerable residents.

“The lack of affordable dental care in America is a problem all over our country,” Sanders has said. “But it is especially acute for lower-income Americans, pregnant women, people with disabilities, veterans, those who live in rural communities, and Black, Latino and Native Americans.”

Sanders also said the lack of access and affordability has become “so absurd” that some Americans travel to Mexico, India, Thailand and other places to get inexpensive dental care.

The senator also said 1 in 5 seniors has lost teeth because of the challenges involved in getting dental coverage.

Medicaid, the federal health care program for low-income Americans, has dental care coverage, but many have had concerns with the way it’s handled.

“The reimbursement rate under Medicaid is so lousy that frankly it’s the illusion of coverage without the power of access,” Louisiana Senator Bill Cassidy said, according to the Pagosa Daily Post in Colorado. “If you’re losing money on every patient you see who’s covered by Medicaid, you can’t make it up.”

The issues surrounding dental care are more concentrated in rural areas, where many residents have to travel miles by car or even plane to get dental care.

Some question adding dental care to traditional Medicare for funding reasons. Since Medicare is set to run out of money for full payments in about 10 years, some lawmakers think adding an additional component to the program could only complicate matters.

“With Medicare on track for insolvency in a little over a decade, we should also think about making that sustainable before adding programs to it,” Cassidy said.

Beene echoes these concerns, saying the eventual decision on how to navigate dental coverage in Medicare will likely come down to finances.

“While the need is there, that would increase the cost of Medicare coverage, and Medicare already has some structural issues that hurt its availability of funding in the coming years,” Beene said. “Sadly, the decision to add coverage could be more of a financial one than a health-needed one.”