Good oral health, including regular checkups, cleanings and oral cancer screenings, can help prevent gum disease as well as tooth decay and tooth loss. However, traditional Medicare does not cover dental carewith few and limited exceptions.
It seems counterintuitive, since oral health is such a thing essential part of overall healthespecially for seniors who may have chronic conditions such as diabetes or heart problems.
Currently, routine care, such as cleanings and fillings, and services such as dentures or extractions, are the responsibility of beneficiaries. There are some narrow exceptions, such as if dental services are closely related to other covered medical care—for example, tooth extraction during surgery to repair a broken jaw or in conjunction with oral cancer treatment or tumor removal. Even then, Medicare won’t cover any follow-up care after the underlying condition is treated, according to the Center for Medicare Rights.
“Essentially, it’s not going to cover anything that we think of as routine dental care that you get just by scheduling a visit to your dentist,” says Louise Norris, health policy analyst for medicareresources.org.
Medicare supplement program (Medigap) won’t cover dental care either. These plans are extensions of original Medicare benefits, so they only match what Medicare pays.
Lack of coverage leads many beneficiaries to simply skip dental care altogether. Nearly half (47%) of all Medicare recipients had not seen a dentist in the past year, according to a 2019 analysis by the Kaiser Family Foundation. Black and Hispanic beneficiaries, those with lower incomes and those rating their health as fair or poor received even less care.
Paying for your own dental care can be expensive—the average dental expense for Medicare beneficiaries in 2018 was $874. one in five spent more than $1,000 on dental care.
Senator Bernie Sanders of Vermont has pressed for dental coverage (as well as hearing and vision coverage) under Medicare for decades. Two bills in Congress, S.842 and HR33, were introduced in March to add these benefits to traditional Medicare. These bills are similar to legislation introduced in previous years without success. While the coverage expansion is popular among Medicare recipients, the measures are strongly opposed by the American Dental Association and AHIP, a trade organization of health insurance providers.
“We could eventually see successful legislation to add dental benefits to Medicare, but it will be difficult to reach an agreement that the ADA and AHIP can support and that legislators will also support,” says Norris.
What Medicare beneficiaries can do for dental care Court fees
People with traditional Medicare can get dental coverage from a current or former employer or through a standalone dental plan. These individual dental plans generally have fairly low benefit caps, but they can be really helpful in covering routine and preventive care, getting people to stick to a regular schedule for checkups and cleanings, and offsetting the costs of more important of dental work, according to Norris.
However, there are ways to get oral health care. If you’re willing to switch to a Medicare Advantage plan, most cover routine dental services like checkups or cleanings, although it can be difficult to find in-network providers. These plans often have high deductibles ($1,000 or more), annual maximums, and high coinsurance for certain procedures.
Medicare recipients who also qualify for Medicaid (known as dual eligibles) can get dental benefits in almost all states and in Washington, D.C. It can be even harder to find dentists who accept Medicaid than those who accept Medicare plans Advantage, due to the limited compensations and service limitations.
According to the Medicare Rights Center, other options for dental care include:
- Reduced cost or free dentistry: These clinics are available in many states. Enter your zip code to find a nearby location.
- Local hospitals: Call hospitals in your area to ask if they offer dental clinics, how you can become a patient there, what services they offer and at what cost, and if payment plans are available.
- Federally certified 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 (CHC): CHCs provide free or reduced-cost health services, including dental care. CHCs are funded by the Health Resources & Services Administration (HRSA).
- Donated dental services programs: These programs work in some 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.
- Integrated Elderly Care Program (STEP): 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 receive some or all of their dental care through a local VA facility.
- The Association of State and District Dental Directors (ASTDD) has information and links to all current state oral health programs.
Study after study confirms the importance of regular oral care for seniors – 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, the researchers say. As the older population continues to grow, so will the pressure on Congress to include dental coverage in traditional Medicare.
