The government health insurance program for adults 65 and older, as well as people of all ages with disabilities, currently covers cancer screenings, mental health services and appointments with specialists, from allergists to urologists. But what about a visit to the dentist? Surprisingly, most dental services aren't covered by Medicare, despite the fact that older adults are at greater risk for dental problems, such as gum disease and tooth loss. Some Medicare beneficiaries have access to dental coverage through other sources, such as Medicare Advantage plans, but the scope of dental benefits, when covered, varies widely and is often quite limited, which can lead to high out-of-pocket costs for those with serious dental needs or not satisfied. A WADA's grassroots How Sick Is Socialized Medicine campaign encouraged doctors to talk to patients about the horrors of universal government healthcare.
The logical rationale for this coverage is that tooth extractions are incidental and integral to covered radiation therapy, even though the procedures are performed at separate times and by different types of professionals. For basic adult dental care, the most common cost-sharing amount is 50% coinsurance after meeting the dental deductible (40% of plans that cover this benefit). Similarly, for major adult dental care, the most common cost-sharing amount is 50% coinsurance after meeting the deductible (58% of plans that cover this benefit). Importantly, the clear language of the legal provision does not prohibit payment for necessary dental services “in connection with the treatment of medical problems that extend beyond teeth and supporting structures.
About 11% of Medicare beneficiaries had access to dental coverage through Medicaid (including those listed above who also have coverage through Medicare Advantage plans). Recognizing the inadequacy of care for the American elderly, the AMA, the ADA and others created the Joint Council to Improve Health Care for the Elderly15 to try to promote a plan that would avoid government functions. This brings us to another big reason why the Medicare benefit package hasn't further increased the cost of the current program. Some plans only limit the amount they will pay for relatively extensive dental benefits (no limit on preventive services), but most members are in plans that limit cost-sharing for both preventive and more extensive services.
Lack of dental care can exacerbate chronic medical conditions, such as diabetes and cardiovascular disease, help delay diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits. Check with the Center for Health Care Strategies Medicaid table to see if your state covers dental services to avoid unexpected costs. The following is the legal analysis of the Center for Medicare Advocacy and does not represent the position or interpretation of the federal Medicare agency (CMS) of its dental coverage policy.
