Despite expanding its coverage of dental procedures for Medicare beneficiaries with certain medical treatments, many clinicians don’t participate in the program. Dental experts told DrBicuspid what needs to happen for the tide to turn.
Dentists said reimbursements need to be better, and there needs to be relief from administrative burdens.
“If we want broader participation, the system must support clinicians operationally -- not just expand eligibility on paper,” Dr. Catrise Austin, a cosmetic dentist in New York City and host of the Let’s Talk Smiles Podcast, told DrBicuspid.
In November 2022, the U.S. Centers for Medicare and Medicaid Services (CMS) expanded access to dental care by finalizing payment for services deemed “integral to covered medical services.” Under the rule, Medicare began in 2023 paying for services, including dental exams and treatment related to or simultaneously with organ transplants, valvuloplasty procedures, and cardiac valve replacements.
In 2024, it expanded access to beneficiaries with head and neck cancer, those receiving high-dose antiresorptive therapy or chimeric antigen receptor T-cell therapy as cancer treatment, and beneficiaries receiving oral healthcare screenings before chemotherapy.
In January, a study published in the Journal of the American Dental Association revealed that the Medicare expansions did not appear to encourage clinicians -- especially oral surgeons -- to participate in the program.
Challenges to participating
Dr. Catrise Austin.
Though Austin recognized that expanding Medicare dental benefits was a “meaningful policy shift,” participation hinges on viability, not willingness, she said. She noted that most U.S. private dental practices are small businesses, which operate independently.
“When reimbursement rates don’t align with overhead, which continues to rise due to staffing shortages, supply costs, and compliance requirements, participation becomes financially challenging,” Austin said.
Another major deterrent is the administrative burden, Austin said.
“Medicare billing is structured differently than commercial dental insurance,” Austin said. “Documentation requirements, medical necessity criteria, and audit risk feel more aligned with hospital systems than solo or small group practices. Without dedicated billing infrastructure, the margin for error is intimidating.”
Dr. Jandra Korb.
Dr. Jandra Korb, the dental director in Oklahoma for DentaQuest, agreed.
“Medicare is a complex labyrinth in terms of covered services and the processes for getting paid, and that payment is generally lower than what a dentist could receive for the same service billed to commercial insurance,” Korb told DrBicuspid.
“If you are a Medicare-enrolled dentist, you also have to certify that the dental service provided was inextricably linked to a Medicare-covered medical service,” Korb continued. “That in and of itself is a challenge given how much more needs to happen for interoperable health record systems and well-established medical-dental integration processes. I think any incentives would need to coincide with simplifying the paperwork and ensuring fair payment for dentists.”
Recommendations for boosting provider participation
Austin said some of the following actions could sway more dentists to participate in Medicare:
- Reimburse at a rate that reflects the true cost of care delivery.
- Simplify billing pathways tailored specifically for dental practices.
- Provide clearer guidance and education for clinicians.
- Implement broader inclusion of preventive services to create sustainable patient flow.
- Offer incentives, including tax credits or implementation grants, to offset onboarding costs.
“Dentists care deeply about access,” Austin said. “But small businesses cannot absorb systemic inefficiencies indefinitely.”
