ADHA, advocacy groups call for Medicare dental benefits

By Theresa Pablos, DrBicuspid.com associate editor

July 30, 2018 -- Multiple health advocacy organizations and the American Dental Hygienists' Association (ADHA) are calling for the U.S. government to add dental benefits to Medicare. The latest movement started after Oral Health America (OHA) published a white paper in support of the concept on June 20.

Beth Truett
Beth Truett, president & CEO of Oral Health America.

The white paper, titled "An Oral Health Benefit in Medicare Part B: It's Time to Include Oral Health in Health Care," outlines how the government might go about adding oral healthcare to the $700 billion program for seniors and people with disabilities. It also details why dental benefits are needed, estimates the potential cost, and includes ADA survey findings of dentists' opinions on the topic.

"The lack of a dental benefit in Medicare affects older adults' overall health, quality of life, and financial stability," stated OHA President and CEO Beth Truett in a press release. "OHA is focused on finding equitable solutions to increase the overall health and wellness of America's seniors. We believe that including a publicly funded benefit in Medicare Part B is a solution that values oral health as key to total health."

Most seniors lack dental insurance

Medicare is designed to cover medically necessary services to treat a disease or condition for adults age 65 and older, as well as those younger than 65 with certain diseases and disabilities.

The program is broken up into different parts, including the following:

  • Part A, which covers hospital and nursing home services
  • Part B, which covers routine and preventive care
  • Part D, which covers prescription drugs

Dental care has been excluded from Medicare since the U.S. Congress first created the program in 1965. Congress later amended Medicare Part A to cover some dental services needed for inpatient hospital services, and some Medicare Advantage plans include dental coverage as a supplemental benefit. However, most dental procedures are still not covered under Medicare.

As a result, about 70% of U.S. seniors lack or have limited dental insurance, according to the authors of the white paper. In addition, 1 out of 5 seniors has untreated tooth decay, and 70% have periodontal disease.

To remedy this, the authors proposed adding comprehensive dental benefits to Medicare Part B as a way to improve the health of Medicare beneficiaries and potentially reduce related healthcare costs.

"Providing dental coverage to older Americans and people with disabilities would close previous gaps in dental use and expense between the uninsured and the insured, and ensure that America's seniors and people with disabilities have access to good oral health throughout their lifetime," wrote the authors, a group of 17 professionals that included dentists, public health officials, and researchers.

Dentist suport for Medicare dental benefits

The idea is popular with the public, with 86% of likely voters supporting the concept, according to white paper. Furthermore, about 70% of dentists strongly or somewhat agreed that Medicare should include comprehensive dental benefits, according to the findings of an ADA survey cited in the paper.

Estimating the cost

The white paper also included an ADA analysis on the potential cost of adding comprehensive dental benefits to Medicare Part B. If the program uses similar cost sharing, surcharges, and premiums to other Part B programs, then adding dental benefits would cost the government about $32 billion, according to the analysis. That comes out to about $14.50 per beneficiary per month, not including the cost for dental implants or any pent-up demand.

"This estimate assumes a general fund contribution of 75% of all costs, similar to the current Medicare Part B funding structure," the authors wrote.

Adequate funding would be especially important for dental care to ensure dentists participate in the program, they noted. This includes providing for the cost of dental services and also accounting for the overhead of running dental practices.

"Practice viability is dependent upon a mix of patients who are eligible for various discounted rates versus full-fee paying patients in a practice," the authors wrote. "Thus, practice overhead, along with total cost of the services relative to discounted fees, will be an important factor for dental practices considering whether to participate in Medicare."

Oral health groups offer support

Multiple health organizations, including the ADHA, Families USA, and the Center for Medicare Advocacy, supported OHA's white paper and the idea of adding comprehensive dental benefits to Medicare.

“It is important to have oral care as a benefit of Medicare.”
— ADHA

"Given the clear connection between oral health and overall health, it is important to have oral care as a benefit of Medicare," the ADHA stated in a press release. "ADHA proudly supports OHA and its partners' push to add oral healthcare as a benefit of Medicare and looks forward to assisting in the efforts of this movement."

Although the ADA contributed data and analysis to the white paper, the organization is not currently supporting the concept. However, ADA members interested in sharing their opinion on the issue can email dentalbenefits@ada.org.

"While the ADA analyzed, computed, and provided data on costs associated with a Medicare dental benefit, ADA input to the Oral Health America white paper does not constitute ADA endorsement of inclusion of a benefit under Medicare at this time," the ADA stated in an email to DrBicuspid.com. "The ADA's Council on Dental Benefit Programs is actively studying this issue in order to make an informed recommendation for the profession."


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