Paying for Dental Care: Putting Teeth in the Law

Published In Blog

September 27th, 2018

People lucky enough to have employers providing them with dental coverage most often lose it when they retire; 70% of seniors 65 and older lack or have very limited dental insurance, according to a recent poll by Oral Health America, a nonprofit that advocates for policies providing access to and coverage for dental care. Probably not coincidentally, that’s the same percentage of seniors who have periodontal disease.

A surprise that comes to many people, especially those newly out of the workforce: Traditional Medicare does not cover any of the costs of routine dental care — including checkups and cleanings, or commonly painfully pricey items and services such as dentures and root canals. Half of all Medicare beneficiaries have annual incomes of less than $26,200, and one-quarter have incomes below $15,250, according to a recent Kaiser study. Their ability to pay for dental care and coverage is obviously severely truncated.

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.

A study recently commissioned by the American Dental Association (ADA) estimated that a comprehensive benefit without dollar caps would cost the federal government about $32.3 billion in 2018. The ADA’s final report includes cost estimates for a number of different models for hypothetical dental benefit offerings under the Medicare program. While the particulars are of probable interest only to the exceptionally wonky, the study and models do provide tangible talking points for legislators and for those advocating for change.

Whatever its cost, there is already a welcoming hue and cry for adding dental coverage to Medicare, as 93% of older adults recently polled said they favored the change. There was even a rare show of agreement from seniors across the spectrum of political leanings, from “very liberal” to “very conservative.” Most said they deemed it essential for plans to cover at least the costs of dental checkups and of pain treatments. And the majority of dentists — more than 71% — tapped in a random nationwide poll also agreed, even signaling a willingness to abide by potentially worky compliance requirements such as learning and reporting diagnostic codes and using electronic health records.

‘We Have Teeth and We Vote’

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.

They include:

  • A website, Tooth Wisdom, that offers information and strategies on improving seniors’ oral health. It includes an interactive map showing affordable dental care throughout the U.S., searchable by Zip code.
  • Demonstration projects that allow for piloting specific interventions, such as a recent one giving pharmacists information and resources to prepare them to answer seniors’ questions about oral health
  • Advocacy, which is now focusing on redoubling efforts to include dental coverage in Medicare; to that end, it publishes a guide, A State of Decay, helps educate legislators and other decisionmakers and Demand Medicare Dental suggesting specific ways consumers can help advocate for the change
  • Professional symposia gathering health professionals and community leaders to share information and inspire reform
  • Health education consisting of courses delivered in community settings, along with a monthly e-newsletter, The Wisdom Tooth Insider.

Leave a Reply