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Contact: Matthew Shepard

July 19, 2018 – Washington, DC – The Center for Medicare Advocacy, along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including the American Dental Association, Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging, Oral Health America and the Santa Fe Group.

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, examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare. Says Center for Medicare Advocacy Senior Attorney Wey-Wey Kwok, “Medicare’s dental exclusion is misguided given the clear connection between oral health and overall health. The time has come to include an oral health benefit that covers preventive services, disease management, and necessary procedures for all Medicare beneficiaries.”

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 bridges, tooth extractions and dentures. The Center for Medicare Advocacy is committed to working with our many dedicated partners to advance access to quality oral health care for Medicare beneficiaries by adding an oral health benefit into Part B, which will improve overall health and quality of life for millions of older adults and people with disabilities.

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.
• 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.
• 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. ADA input to this white paper does not constitute endorsement of inclusion of a dental benefit under Medicare at this time. The ADA is currently investigating a number of options to serve the dental care needs of a growing elder population.

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 as it covers 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 health solutions and provider participation.
• Simplifies a potentially confusing program and process for providers and beneficiaries.
• Uses established 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.

“Research demonstrates that oral health disparities exist for many racial and ethnic groups, by socioeconomic status, gender, age and geographic location. This underscores the need to approach oral health disparities as a component of social justice,” says Center for Medicare Advocacy Policy Attorney Kata Kertesz.

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.