The Center for Medicare Advocacy is pushing the Centers for Medicare & Medicaid Services and Congress to expand dental plan coverage under Medicare.
Currently, the federal healthcare program does not pay for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures supporting the teeth, explained Wey-Wey Kwok, a senior attorney for the center who spoke during a webinar on Wednesday. She noted that a myth persists that Medicare covers dental procedures if they are performed in the hospital. Only Medicare Part A will cover some of the hospital stay.
What does Medicare cover in the oral health department?
“Not much,” Kwok noted.
Some 65% of Medicare beneficiaries, or 37 million people, have no dental coverage, Kwok pointed out on the webinar. Also 49% of Medicare beneficiaries did not see a dentist in the last year, with large percentages of Black, Hispanic, disabled non-elderly and low-income people taking a pass, Kaiser Family Foundation reported in 2019. A total of 89% who used dental services incurred an average $922 in out-of-pocket costs, according to Kaiser.
The problem of lack of coverage has serious consequences, including persistent pain, infection and inflammation; costly emergency room visits and hospitalizations; and social isolation, which can affect cognitive health, Kwok said.
The Center for Medicare Advocacy, a nonprofit organization that works to advance access to comprehensive Medicare coverage for older people and people with disabilities, wants CMS to expand the scope of medically necessary coverage. This includes when a covered medical procedure or treatment cannot proceed or will be negatively compromised unless the patient’s dental/oral problem is treated or resolved.
Also, the center is advocating for legislation to add a comprehensive oral benefit to Medicare Part B. This benefit likely would be paired with vision and hearing benefits, Kwok said.