Ask the Advisor: September/October 2022

What Happened To The Effort To Add Dental Benefits To Medicare?

Q:  I recently had to get a tooth extracted.  The practice that performed the oral surgery required me to sign a waiver stating that they do not participate in Medicare, and that my services would not be covered by Medicare.  What’s the status on adding a dental benefit to Medicare?

A: Under current law, Medicare doesn’t cover dental services except under very limited circumstances.  It doesn’t cover routine checkups, cleanings, fillings, tooth extractions and dentures.  A year ago, Members of Congress discussed adding a dental benefit to Medicare to make dental care more affordable, but the effort stalled in our very divided Congress.

The need for dental coverage is substantial.  According to TSCL surveys, about half of all retirees — an estimated 24 million people — don’t have dental insurance.  Those lacking coverage report postponing getting care due to cost.  According to TSCL surveys, even those who do have dental coverage say their plans leave a lot uncovered.  Only 16% of TSCL survey participants with dental insurance said they were “very satisfied” with it.

Last fall, President Biden scrapped efforts to add dental coverage to traditional Medicare out of concerns for the cost by moderate Democrats who called for paring down the enormous size of his Build Back Better legislation which originally was proposed to cost $3.5 trillion.

In the meantime, Members of the U.S. Senate and House of Representatives sent letters to the Centers for Medicare and Medicaid Services (CMS) urging the Biden Administration to expand access to medically necessary dental care under the Medicare program.  Lawmakers expressed the need to expand coverage noting that doing so can improve the health of Americans enrolled in Medicare and reduce medical costs for the program.

However, providers such as your dentist who don’t participate in Medicare cannot be compelled to provide services by Medicare.  They must first be under contract with Medicare.

TSCL has not given up on the effort to add dental care to Medicare.  Poor oral health can exacerbate the risk of many chronic conditions that many Medicare beneficiaries already face, such as heart and kidney disease, cancer, and diabetes.  Researchers have even found a link between the type of bacteria that’s common with periodontal disease and Alzheimer’s disease.  This in turn can drive up Medicare costs, causing retirees to spend more of their savings on Medicare premiums and out of pocket costs and to carry more medical debt.

TSCL continues to support this effort and believes that good oral health can help reduce Medicare costs for both the federal government and Medicare beneficiaries.