Does Medicare cover dental care? What beneficiaries need to know
Good oral health, including regular checkups, cleanings, and oral cancer screenings, can help prevent gum disease as well as tooth decay and loss. Yet traditional Medicare does not cover dental care, with very few and limited exceptions.
It seems counterintuitive, since oral health is such a key part of overall health, especially for older people who may have chronic health conditions like diabetes or heart problems.
Currently, regular care like cleanings and fillings, and services like dentures or extractions, are the responsibility of beneficiaries. There are some narrow exceptions, like if dental services are closely related to other covered medical care—for example, a tooth extraction during surgery to repair a broken jaw, or in conjunction with treatment for oral cancer or tumor removal. Even then, Medicare won’t cover any follow-up care after the underlying condition is treated, according to the Medicare Rights Center.
“Essentially, it’s not going to cover anything that we think of as routine dental care that you get by just scheduling a visit to your dentist,” says Louise Norris, a health policy analyst for medicareresources.org.
Your Medicare Supplement Plan (Medigap) won’t cover dental care either. These plans are extensions of original Medicare benefits, so they only align with what Medicare pays for.
Lack of coverage leads many beneficiaries to just skip dental care altogether. Almost half (47%) of all Medicare recipients did not have a dental visit within the past year, according to a 2019 analysis by the Kaiser Family Foundation. Black and Hispanic beneficiaries, those with lower incomes, and those who rate their health as fair or poor received even less care.
Paying for your own dental can be costly—average Medicare beneficiary dental spending in 2018 was $874; one in five spent more than $1,000 on dental care.
Senator Bernie Sanders of Vermont has been pushing for dental coverage (as well as hearing and vision coverage) under Medicare for decades. Two bills in Congress, S.842 and H.R.33, were introduced in March to add these benefits to traditional Medicare. These bills are similar to legislation introduced in previous years without success. While expanding coverage is popular with Medicare recipients, the measures are strongly opposed by the American Dental Association and the AHIP, a trade organization of health insurance providers.
“We could eventually see successful legislation to add dental benefits to Medicare, but it will be challenging to work out a deal that the ADA and AHIP can support, and that lawmakers will also support,” Norris says.
What Medicare beneficiaries can do about dental care costs
People with traditional Medicare can get dental coverage from a current or former employer, or via a stand-alone dental plan. These stand-alone dental plans generally have fairly low benefit caps, but they can be really useful in covering routine and preventive care, getting people to stick to a regular schedule for check-ups and cleanings, and offsetting the cost of more significant dental work, according to Norris.
However, there are ways to obtain oral health care. If you’re willing to switch to a Medicare Advantage plan, most do cover routine dental services, such as checkups or cleanings, although it can be challenging to find in-network providers. These plans often have high deductibles ($1,000 or more), annual caps, and high co-insurance for certain procedures.
Medicare recipients who also qualify for Medicaid (known as dual-eligibles) can get dental benefits in nearly all states and in Washington, D.C. It can be even harder to find dentists who accept Medicaid than those who accept Medicare Advantage plans, due to the limited reimbursement and restrictions on services.
According to the Medicare Rights Center, other options for dental care include:
Reduced-cost or free dental clinics: These clinics are available in many states. Type in your zip code to find a nearby location.
Local hospitals: Call the hospitals in your area to ask if they offer dental clinics, how you can become a patient there, which services they offer and at what cost, and if payment plans are available.
Federally qualified health centers (FQHCs): FQHCs are health care facilities located in medically underserved areas. People with Medicare are eligible to receive services from an FQHC. Some FQHCs may offer dental care.
Community health centers (CHCs): CHCs provide free or reduced-cost health services, including dental care. CHCs are funded by the Health Resources & Services Administration (HRSA).
Donated dental service programs: These programs operate in certain states. Dentists in these programs offer free dental services if you qualify.
Dental schools: Some dental schools provide low-cost dental care. Dental students work with patients under the supervision of experienced, licensed dentists.
Program of All-Inclusive Care for the Elderly (PACE): PACE is a program available in some states to people with Medicare and Medicaid who need a nursing home level of care.
Veterans Administration (VA): Veterans may qualify for VA dental care benefits and may be able to get some or all of their dental care through a local VA facility.
The Association of State and Territorial Dental Directors (ASTDD) has information and links to all current state oral health programs.
Study after study confirms the importance of regular oral health care for older adults—and not just to avoid more serious problems down the road. Good dental care can also mean more social interaction and improve quality of life, nutritional status, and mental health, say researchers. As the older population continues to grow, so will pressure on Congress to include dental care coverage under traditional Medicare.
This story was originally featured on Fortune.com
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