The Case for a Medicare Dental Benefit

Older adults may not know it, but they were incredibly close to having Medicare cover comprehensive dental benefits for the first time in the program’s 57-year history. Support for enhancing Medicare by adding dental coverage was strong, but, ultimately, the benefit was not included by lawmakers in the pared-down legislative package passed by Congress. However, the debate has sparked an ongoing conversation—one that suggests it is no longer a question of “if” but “when” Medicare will ensure older adults and people living with disabilities have access to whole-person care. The reason to include dental coverage in Medicare is simple: oral healthcare is healthcare.

Wide-Ranging Impact of Poor Oral Health

Poor oral health has a direct link to higher risks of chronic illnesses, including cardiovascular disease, diabetes, hypertension, asthma, and more.¹ It can lead to greater instances of depression and other mental health disorders.² An individual’s inability to access dental care presents a clear threat to his or her overall health.

The COVID-19 pandemic provided a clear, but devastating example of the importance of oral healthcare. In September 2020, at a time when ventilators were frequently used in the care of patients with severe COVID-19 infections, the DentaQuest Partnership released a report examining the connection between oral health and ventilator-associated pneumonia (VAP).³ VAP is the leading cause of hospital-acquired infection deaths among critically ill patients.

The results of the study were startling: preventive dental visits decreased the likelihood of acquiring VAP. At least one preventive dental visit within 3 years reduced the likelihood of a VAP diagnosis by 22%. This study adds to the mounting research that demonstrates the life-sustaining importance of oral healthcare.³

But when adults turn 65 and receive their welcome package from Medicare, they are often surprised to learn that their new health plan neglects to cover dental care, something they’ve likely had through their employer their entire adult life. As a result, about half of Medicare beneficiaries don’t have any dental coverage at all. Around the same number haven’t visited a dentist within 12 months.⁴

And the lack of coverage means higher costs for patients. Research from 2021 shows that Medicare or Medicare Advantage enrollees paid for three quarters of their total dental costs out of pocket.⁵

The reason to include dental coverage in Medicare is simple: oral healthcare is healthcare.

Without dental coverage, older adults are less likely to visit the dentist. According to a recent national survey conducted by CareQuest Institute for Oral Health, 16% of adults who reported they were without dental insurance had not seen a dentist in more than 5 years. This is more than 10% higher than the number of respondents with dental insurance who had not seen a dentist. Further, 40% of adults lacking dental insurance who had not seen a dentist in the past 2 years identified cost as the reason.⁶

Without adequate oral healthcare, health conditions can worsen, which is not only negative for the individual but it also leads to increased overall health costs. In fact, preventive dental care saves money because healthy people require less care. One study published in the American Journal of Preventive Medicine found that oral healthcare resulted in significantly lower healthcare costs for people with certain chronic illnesses when compared to those with the same illnesses who did not receive oral healthcare.⁷

Healthcare costs in the United States are exorbitant. However, medical expenses associated with treating type 2 diabetes and coronary artery disease were reduced by 40% among those who received oral healthcare.⁵ With nearly one in five Medicare beneficiaries diagnosed with type 2 diabetes, the savings achieved by increasing access to oral healthcare would be significant.⁸

Increasing access to oral healthcare by adding a dental benefit to Medicare saves money, promotes overall health, and addresses inequities…

Preventing the Need for Emergency-Based Oral Healthcare

Preventive dental care covered by insurance also keeps people out of emergency departments for oral health emergencies or related pain. Emergency departments are generally not equipped to treat oral health issues and the care is incredibly costly. A CareQuest Institute study found that in 2019 alone, 1.8 million emergency department visits for nontraumatic dental conditions resulted in charges of $3.4 billion. Furthermore, Black adults were 44% more likely than white adults to find themselves in a hospital emergency department for dental care—just one example of the many racial disparities that exist in oral healthcare.⁹

Addressing Health Inequities Across the United States

Increasing access to care by adding a dental benefit to the Medicare program is a critical way to address such pervasive health inequities. Research demonstrates that when healthcare coverage is expanded, racial and ethnic disparities narrow.¹⁰ With the implementation of the Affordable Care Act, health inequities were noticeably reduced—but not eliminated—and there is more work to do.

A recent CareQuest Institute survey revealed that almost 60% of Black adults have lost one or more permanent teeth due to caries or periodontal diseases, a 15% higher rate of tooth loss among all adults. The survey also found that Black adults are 10% more likely than white adults to report their oral health as fair or poor.⁶

Increasing access to oral healthcare by adding a dental benefit to Medicare saves money, promotes overall health, and addresses inequities that result from a healthcare system that was not built for everyone.

It’s no wonder, then, that the idea is incredibly popular across the United States. Another CareQuest Institute survey, conducted in February of 2021, shows that nearly every American supports the benefit, with 94% of respondents in favor of the idea.⁶

Perhaps its universal popularity is the most compelling reason why a Medicare program that includes a dental benefit is closer than ever. Whatever the motivation, adding a dental benefit to Medicare is a win for older adults and people with disabilities as well as taxpayers, and it is excellent public policy.

References

1. CareQuest Institute for Oral Health. Impacts Beyond the Mouth.
2. CareQuest Institute for Oral Health. How Depression Is Linked to Oral Health.
3. Thakkar-Samtani, M, Linson, M, Tranby, E. The Link Between Ventilator-Associated Pneumonia and the Mouth: The Intersection of VAP, COVID-19, oral health, and equity. Boston, MA: CareQuest Institute for Oral Health; September 2020
4. Freed M, Ochieng N, Sroczynski N, Damico A, Krutika A. Medicare and Dental Coverage: A Closer Look.
5. CareQuest Institute for Oral Health. Why We (Still) Need to Add Dental to Medicare. Boston, MA. CareQuest Institute for Oral Health; November 2021.
6. CareQuest Institute for Oral Health. How’s America’s Oral Health? Barriers to Care, Common Problems, and Ongoing Inequity.
7. Jeffcoat M, Jeffcoat R, Gladowski P, Bramson J, Blum J. Impact of periodontal therapy on general health. AJ J Prev Med. 2014;47:166–174.
8. Hasche J, Ward C, Schluterman N. Diabetes occurrence, costs, and access to care among medicare beneficiaries aged 65 years and over.
9. CareQuest Institute for Oral Health. Recent Trends in Hospital Emergency Department Visits for Non-Traumatic Dental Conditions.
10. Guth M, Artiga S. Effects of the ACA Medicaid Expansion on Racial Disparities in Health and Health Care.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2022;9(10):18-20.