Oral Health America (OHA), along with a diverse group of partners, released a white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care. This white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, healthcare and dental fields, including Oral Health America, the American Dental Association, Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging and the Santa Fe Group.
With an expected 72.1 million seniors living in the United States by 2030, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare.
"The lack of a dental benefit in Medicare affects older adults overall health, quality of life and financial stability," said Beth Truett, President & CEO of OHA. "To ensure access to care, we must provide coverage to pay for care. OHA is focused on finding equitable solutions to increase the overall health and wellness of America’s seniors. We believe that including a publicly funded benefit in Medicare Part B is a solution that values oral health as key to total health."
Medicare plays a key role in providing health and financial security to 59 million older people and younger people with disabilities. However, traditional Medicare does not include coverage for routine oral health care like checkups, cleanings and x-rays, or restorative procedures like fillings or bridges, tooth extractions and dentures.
“Medicare's dental exclusion is misguided given the clear connection between oral health and overall health,” said Wey Wey Kwok, JD, Senior Attorney at the Center for Medicare Advocacy. “The time has come to include an oral health benefit that covers preventive services, disease management and necessary procedures for all Medicare beneficiaries.”
An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes. Top findings include:
-70 percent of all Medicare recipients lack or have limited dental insurance and fewer than half access dental care each year.
-Cost is the number one reason that older adults have not gone to the dentist in the past year.
-Integrating dental coverage in Medicare would close disparities in dental use and expense between the uninsured and insured and among older adults with few financial resources and limited oral health education.
-Surveys show that consumers widely support adding oral health coverage to Medicare and prioritize two categories of care: checkups and pain treatment.
-71.2 percent of dentists agree that Medicare should include comprehensive dental benefits and a majority indicated they were willing to comply with typical Medicare practice requirements.
-The ADA recently commissioned a study that analyzed the cost structure for various dental benefit designs within Medicare. This study estimated that a comprehensive benefit without dollar value caps would cost the federal government between 31.4 billion dollars in 2016 dollars, $32.3 billion in 2018; the estimated base premium increase for a Part B benefit would be $14.50 per beneficiary per month. ADA input to this white paper does not constitute endorsement of inclusion of a dental benefit under Medicare at this time. The ADA is currently investigating a number of options to serve the dental care needs of a growing elder population.
An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care recommends the addition of a comprehensive oral health benefit to Medicare Part B as it covers outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services. Advantages to the inclusion of Part B include:
-Ensures that everyone enrolled in Medicare will receive the oral health benefit.
-Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable health solutions and provider participation.
-Simplifies a potentially confusing program and process for providers and beneficiaries.
-Uses established protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.
To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They also must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare Statute.
“Millions of older Americans lack the resources to maintain their oral health over their lifetime, which will negatively impact their general health and well-being,” said Elisa Chavez, DDS, Scholar of the Santa Fe Group. “[We are] one of many groups advocating for federal legislation to remove the dental exclusion in Medicare in order to make possible a dental benefit and a more coordinated, cost effective model of comprehensive health care.”
The recommendations included in An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care stresses the importance of an oral health benefit for older adults. Read more abo the medical necessity, costs, proposed structure and legislative changes needed at oralhealthamerica.org/medicaretoolkit.