A WEAK EFFORT AT MEDICARE DENTAL COVERAGE
By Richard Davis
It may be a case where we should be thankful that there is at least a recognition that the mouth needs insurance coverage as much as the rest of the body. According to a recent article in Health Affairs, “Medicare Parts A and B will begin coverage of dental treatment to eliminate oral infection prior to solid organ transplant and select cardiac procedures in 2023, and prior to head and neck cancer treatment in 2024. CMS will also generate an annual review process for coverage of other medically necessary dental treatment.”
This is extremely narrow coverage that will not affect a lot of people but it is a start. In 2019 and 2021 the U.S. House passed a Medicare dental benefit bill but the U.S. Senate did not adopt it. The Build Back Better Act originally included Medicare dental coverage but that was removed because of lobbying by the American Dental Association.
One might think that dentists would feel some sort of obligation to ease the burden of high dental costs in the country and at least support measures to provide better access to dental care for seniors. But every time state or federal government tries to broaden access to dental coverage dental societies lobby hard to make sure they protect their own.
The provision of dental care in this country is first a business and second a health care service. Dentists have not had to play by the same rules as other providers of health care and that is a major reason why access to dental care is so unaffordable for too many people.
Health Affairs notes that, “Across the life span, cost remains the most commonly reported barrier to dental access in the United States. Older adults have the lowest rates of dental insurance of any demographic group. Medicare beneficiaries with a dental visit spend an average of more than $800 out of pocket each year for their dental care, and only 53 percent see a dentist at all. Some Medicare Advantage plans, which provide coverage to nearly half of those enrolled in Medicare, may offer more robust dental coverage, but out-of-pocket dental costs and low utilization rates are comparable to those with traditional Medicare.”
While the new Medicare dental coverage is too little too late, it is a start. It will become part of Medicare A and B along with other inpatient and outpatient services. In addition, this benefit will create the mechanism to pay for dental care and that also means that Medicare will determine what quality dental care means and what services should be covered.
It is likely that Medicare reimbursement for dental services will be less than what dentists charge. That means they may say they are not accepting Medicare patients and they will be able to deny medically necessary care because they can’t make enough money from Medicare patients.
Dental societies know that whatever kind of benefit Medicare offers it means that their constituents will make less money for specified procedures. Anytime the income of dentists is threatened their lobbyists jump into action.
The political will to provide Medicare dental benefits has little to do with doing the right thing by seniors and more to do with the age old claims that providing a new benefit will cost too much. But Medicare already pays for some dental care when people show up in the emergency department. In 2018 there were 213,700 Medicare reimbursed emergency department visits for dental problems costing more than $1100 per visit. As usual, government programs remain reactive instead of proactive.
The Health Affairs piece ends with questions that politicians and dentists should be forced to answer. They must be held accountable for the pain and suffering caused by lack of affordable dental care. “Is it medically necessary for a person to be able to chew? To smile? To be free from preventable pain? These answers may depend on what is currently politically feasible, rather than what is just.”
Thank you for posting this. It is outrageous that our teeth are considered a different “commodity” from the rest of our bodies. As you point out, it’s all about the money. The fact that people go to the ED for emergencies that could have been prevented by access to dental care is outrageous and inhumane.
Meanwhile, adults on Medicaid have a modest dental benefit, but it’s near impossible to find dentists who take Medicaid and are taking new patients. And many dentists won’t do certain procedures for Medicaid patients because the benefit is so limited.
Another part of this picture is the growing role of Private Equity in dental care. Private Equity is all about maximizing returns on investment. It has nothing to do with healthcare, except that PE has found that certain sectors of the healthcare world, including dentistry, are ripe for the kind of profiteering they specialize in. I just read a book called Ethically Challenged by Laura Katz Olson, about the role of PE in healthcare. There’s a whole chapter on dental care, which is both eye-opening and infuriating.