Updated April 2025

People lucky enough to have employers providing them with dental coverage most often lose it when they retire. As of 2023, a third of adults who are 60 or over lacked dental insurance, according to a survey by the CareQuest Institute for Oral Health, a nonprofit that advocates for policies providing access to and coverage for dental care. Another 9% of seniors have dental coverage through a Medicare Advantage plan. As the CareQuest Institute notes, “the scope of dental benefits under Medicare Advantage plans varies widely and is quite limited, often resulting in high out-of-pocket costs for individuals with severe dental needs.”

Probably not coincidentally, about 68% of adults who are 65 or older have gum disease, while 20% have lost all their teeth. Poor oral health care also contributes to advanced periodontal disease, dry mouth, and oral cancer.

And Medicaid (known as Medi-Cal in California), the program providing health insurance for people with even lower incomes, mandates coverage only for children 19 and younger; adults are covered only if the state in which they live opts to provide it — and, with the exception of some services that qualify as “emergency,” the states offer a scrawny patchwork of coverage; several do not provide any coverage at all.

Far-Reaching Effects

Without help in paying for coverage, many older people are forced to delay or do without the dental care they need. And as a result of that, many suffer setbacks in their overall health, even beyond the pain and infections caused by tooth and gum conditions. Other adverse affects of poor dental health can include:

• an inability to get sufficient nutrition, causing weight loss or gain;
• a worsening of existing chronic conditions such as hypertension and diabetes; and
• ongoing infections due weakened immune systems.

There are also potential hits to self-image that may come from being self-conscious about missing or diseased teeth, leading to social isolation, depression, and loneliness.

Those who are homebound or live in care facilities are often hit the hardest — both by the inability to pay for and access dental care, and by the diseases and other ill effects caused by poor dental health.

Ready for Change

Many senior advocates argue that the only way to bridge the gap in care between those who have and do not have savings and coverage is to add a comprehensive dental benefit to Medicare and Medicaid coverage.

The Congressional Budget Office determined that a congressional proposal to phase dental coverage into Medicare would cost the government about $238 billion over ten years. The American Dental Association estimates [https://www.ada.org/advocacy/legislative-action-center/medicaid-dental-benefit-act] that making dental coverage available to Medicaid beneficiaries in states that don’t currently cover dental services would cost those states about $1.1 billion. The ADA also estimates that disease prevention resulting from preventative care would reduce that expense to $836 million per year.

Whatever its cost, there is already a welcoming hue and cry for adding dental coverage to Medicare, as 92% of voters polled in 2024 favored the change. Republicans and Democrats alike would like to see a dental benefit added to Medicare. The American Dental Association also supports increased coverage of dental procedures through Medicare and Medicaid.

One dedicated group advocating for change is Oral Health America (OHA) with its favored slogan for seniors: “We Have Teeth and We Vote.” OHA recently launched the Wisdom Tooth Project, which gives specific ways for people to become informed and advocate for change. The project encompasses five strategies aimed at improving the lives of older people especially vulnerable to oral disease.

(This article was revised April, 2025 since it originally published September, 2018.)