A recent announcement from the Centers for Medicare and Medicaid Services (CMS) signals a possible expansion of dental services available for Medicare beneficiaries.
Proposed changes to the procedures covered under Medicare would be a significant step in the right direction. NCOHC commends CMS for this historic move toward a more equitable oral health care system for older adults, and look forward to further expansion of services to ensure comprehensive oral health care for a population that is sadly often left out of the conversation
Specific details are still somewhat uncertain, but any changes to Medicare’s dental coverage would be limited to its current framework in which dental services are tied to other medical procedures.
Background: Medicare and Dental Coverage — Reinforcing a Historic Divide in Care
Medicare is currently only allowed to reimburse for limited dental procedures deemed necessary to treat a covered medical condition. For example, an infected tooth removal may be covered if the patient is about to begin radiation treatment for certain cancers.
The structure as it currently exists ignores several factors, including the fact that oral disease can significantly impact a person’s quality of life, regardless of other medical conditions. It also ignores the oral-systemic connection and the many diseases and health conditions that can result from poor oral health.
Nearly a year ago, NCOHC Director Dr. Zachary Brian published his thoughts on the need for a Medicare Dental Benefit.
In Brian’s words, “Dental coverage under Medicare is sorely needed, but to make Medicare dental benefits anything but universal diminishes the message that public health-minded dentists have fought so hard to advance: that oral health is overall health.”
Any changes to Medicare’s dental coverage outside of the current framework tying oral health care to other medical procedures would need to happen through legislation. Earlier in 2022, Congress appeared on the brink of passing a Medicare dental benefit. The change, championed by Senator Bernie Sanders (I-VT), nearly made it into the Inflation Reduction Act. The provision didn’t make it into the bill, but momentum appears to be building behind a more comprehensive dental benefit.
What Could Change with Dental Benefits Under Medicare, and When?
The proposed changes to Medicare coverage put forward by CMS could take effect as early as January 2023. The changes would include an expansion of covered dental services associated with the success of other covered medical procedures – they wouldn’t include any standalone dental services.
While this expansion is necessary, NCOHC also looks forward to more movement in support of adding a full dental benefit for Medicare participants. The timeline of this type of action is much more uncertain and will depend in no small part on the outcome of the 2022 midterm elections.
A Call to Action
Older adults are too often left out of the conversation when it comes to oral health care, especially preventive oral health care. Our current structures reinforce a mindset that certain oral health outcomes are inevitable.
The reality, however, is that most oral disease is entirely preventable, even for older adults. That means that tooth loss and the need for dentures, for example, are not simply foregone conclusions associated with age. With proper care, anyone can live a full life with their natural teeth.
An expansion of Medicare services to include a dental benefit is a necessary step as we work toward a more equitable future. This change requires legislation at the national level, and it is on all of us to help advocate for this change.
NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.