Policy Brief

To:  Bob Cook-Deegan
From:  Lingqiao Chen
Date:  July 18, 2021
Re:  Expanding Dental Coverage for Medicare Beneficiaries

Statement of Issue: Based on the report from US Census, the number of US adults aged 65 years or older is expected to reach 24% of the overall population by 2060. Their health and well-being should be a priority in public health. Oral conditions particularly affect older adults, especially those who are economically disadvantaged. 96% of adults aged 65 years or older have had a cavity and 1 in 5 of them have untreated tooth decay. 68% of adults aged 65 years or older have gum disease. Despite the prevalence of dental disease, dental care is excluded from Medicare coverage. Medicare does not cover cleaning, treatment, dental filling, removal, or replacement. 65% of Medicare beneficiaries don’t have any dental converge. Even though some Medicare Advantage plans offer dental benefits, the coverage is often limited. Without adequate dental coverage, many Medicare beneficiaries choose to forgo non-urgent dental care, which exposes them to potentially preventable complications and expensive out-of-pocket expenses.

• Dental problems significantly decrease the quality of life. Dental problem is a chronic disease that’s often being overlooked. Oral conditions cause pain and infection that affect eating, speaking, and social interaction. About 1 in 5 adults aged 65 years or older are edentulous and the prevalence increases with age. Having missing teeth can lead to nutritional deficiencies and social isolation.
• The cost of dentist visits without insurance coverage is a great barrier to access. 10% of the Medicare beneficiaries forgo dental care in 2016 due to cost. The financial barrier causes more problems for those with low income and poor health. Average out-of-pocket spending on dental services was $922 in 2016. This is expensive considering half of the Medicare beneficiaries had income below $26,200 per year.
• Preventative dental care curtails future dental costs. Many dental complications are preventable. Cigna Health calculates that adults who don’t receive preventive care will have a 43% increase in their annual dental cost over the same period of time.
• Untreated dental conditions can lead to other health conditions. According to Mayo Clinic, oral bacteria and inflammation seen in periodontitis might contribute to various diseases such as endocarditis, cardiovascular disease, and pneumonia.

Policy Options:

• Standardize dental benefits across Medicare Advantage plans. For Medicare Advantage plans that offer dental benefits, the dental benefit package is standardized to include annual oral exams, cleaning, dental x-rays, diagnostic services, restorative services, treatments of dental conditions, and prosthodontics.
  • Advantage: Medicare Advantage beneficiaries who signed up for plans that include dental coverage will receive a more comprehensive benefit package. The benefits are standardized across plans, making the choices less complicated for these enrollees. Since this approach only makes changes to the Medicare Advantage plan, the impact on Medicare spending will be less. 
  • Disadvantage: This policy only targets a limited population. Dental care access does not improve for those who don’t have Medicare Advantage plans. With a standardized package, the premiums will rise for every participant. People who only need basic dental care will end up paying for services that they don’t need.

• Adding only essential dental service to Medicare as a separate plan (Like Plan D). The benefit package will be similar to the ones covered by Medicaid, which includes one annual preventative care visit, one cleaning every six months, routine procedures, and three total dental office visits per year. 
  • Advantage: This approach expands Medicaid-covered dental benefits to all Medicare enrollees regardless of their income level. The preventative services covered under this plan will detect oral conditions at an earlier stage, and prevent more costly complications in the future. The plan is voluntary; people can choose not to enroll if they are covered by private dental insurance. 
  • Disadvantage: There will still be a portion of people without dental insurance because this plan is not mandatory. Enrollees will still be financially responsible for expensive procedures such as root canals and implants. The plan doesn’t benefit people who are dually eligible for Medicare and Medicaid because they already have these benefits under Medicaid. Since this will be a new part under Medicare, extra effort needs to be put in to determine the premium and cost-sharing method. In addition, having a new part under Medicare can make Medicare policy more complicated for the enrollees.  

• Adding a comprehensive dental benefit package to Medicare as a separate plan. The dental benefit package will cover one annul preventative care visit, other necessary procedures, treatments, and prosthodontics. Patients who qualify for Medicare and Medicaid will be automatically enrolled in this dental plan. Other Medicare beneficiaries can voluntarily sign up. 
  • Advantage: This policy will help low-income patients get comprehensive benefits that are not originally covered by Medicaid. The plan is voluntary; people have the option to not sign up. Costly but necessary procedures will be covered under this policy. People will less likely to forgo needed treatment due to cost. 
  • Disadvantage: The disadvantages of this policy will be similar to the above option; the plan is not mandatory, so it’s unlikely that it will cover all Medicare beneficiaries. With more intensive coverage, the premium and Medicare spending will likely increase. This is likely to replace Medicare Advantage plans and other private dental insurance, which further shifts the cost to Medicare.

• Adding dental care package to existing Medicare Part B benefits. The package will include one annual preventative care visit, other necessary procedures, treatments, and prosthodontics. This additional dental care package will be subjected to Part B’s cost-sharing method. Preventative care will be provided without cost-sharing; other services and treatments will be subjected to 20% coinsurance. 
  • Advantage: All Medicare beneficiaries with Part B benefit will get dental coverage under this policy. Low-income patients who are dually eligible for Medicare and Medicaid will receive a more comprehensive benefit package. This policy will build on existing Medicare Part B; no additional policy is needed to decide on cost-sharing methods.
  • Disadvantage: With extensive dental coverage, the premium for Part B and Medicare spending will likely increase. The dental coverage will be embedded in Part B. Therefore Part B enrollees don’t have a choice to not enroll in this dental plan. They will need to pay a higher premium for this additional service that they might not use. 

Policy Recommendation:

With a rising Medicare-eligible population and the prevalence of dental conditions in this age group, Medicare should expand its coverage to provide dental services. Adding a dental care package to the existing Medicare Part B benefit will be the best option. This approach will bring dental coverage to almost all Medicare beneficiaries. It covers a wide scope of services that will meet each enrollee’s individual needs. This policy especially improves the access to quality dental care for low-income patients. Their premium will be waived under standard Part B policy and they will receive a more comprehensive benefit package. This helps to address the health disparity issue seen in the low-income group. Compare to other options, this approach is easier to implement because it builds upon the existing policy. Moreover, Medicare Part B is financed through both individual premium and federal revenue. The expected increase in premium will be within a reasonable range because individual premium only contributes to 25% of the total cost. 

Sources:

Carter, Julie. “Lack of Dental Coverage Has Real Costs and Consequences for People with Medicare.” Medicare Rights Center, 14 Mar. 2019, www.medicarerights.org/medicare-watch/2019/03/14/blog-lack-dental-coverage-real-costs-consequences-people-medicare.

“Dental Care and Medicare Beneficiaries: Access Gaps, Cost Burdens, and Policy Options.” Commonwealth Fund, 6 Dec. 2016, www.commonwealthfund.org/publications/journal-article/2016/dec/dental-care-and-medicare-beneficiaries-access-gaps-cost.

“Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries.” KFF, 13 Mar. 2019, www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries.

“Oral Health: A Window to Your Overall Health.” Mayo Clinic, 4 June 2019, www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475?reDate=06072021.

“Oral Health for Older Americans | Adult Oral Health | Basics | Division of Oral Health | CDC.” CDC, www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm. Accessed 6 July 2021.

“Policy Options for Improving Dental Coverage for People on Medicare.” KFF, 18 Sept. 2019, www.kff.org/medicare/issue-brief/policy-options-for-improving-dental-coverage-for-people-on-medicare.