At a May 16 hearing of the U.S. Senate Committee on Health, Education, Labor and Pensions, experts argued for adding comprehensive dental coverage to Medicare and Medicaid insurance.
In her written testimony, Lisa Simon, MD, DMD, an associate physician at Brigham and Women’s Hospital in Boston, said that working as a dentist at a community health center “broke my heart. The wait for my services routinely exceeded four months, and I was often forced to extract teeth that I could have saved due to insufficient Medicaid funding.”
Ultimately, Simon went to medical school to work on the oral health crisis from both sides of the aisle. “While in medical school, I practiced dentistry in the Suffolk County Jail, where several patients told me that the only good thing that happened to them since they were incarcerated was that they were finally able to see a dentist,” he said.
He noted that Medicare has been prohibited from providing dental benefits since 1965, which has caused substantial harm to seniors and people with disabilities. “This must be reversed. Less than half of Medicare beneficiaries visit a dentist each year; When they do, they spend more than $1,000 out of pocket on their care.”
Patients delay dental care because it costs more than any other healthcare service.
Dental plans are often a draw for beneficiaries to choose Medicare Advantage, and dental benefits are the most publicized supplemental benefit offered by MA plans. Although 98% of Medicare Advantage beneficiaries are enrolled in a plan that supposedly offers a dental benefit, Simon said his research has shown they have equivalently low dental access rates and equally high out-of-pocket costs. “Medicare Advantage is not the solution,” Simon said.
Simon said the Congressional Budget Office estimated that a universal Medicare dental benefit would cost $23.8 billion per year, less than the cost to Medicare of the only discontinued Alzheimer’s drug Aduhelm (aducanumab). This estimate does not take into account the potential cost savings that would result from reduced hospitalizations for pneumonia, fewer complications from cancer treatment, lower rates of frailty and malnutrition, and the long-term benefits of preventive care.
As for Medicaid, Simon said the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit confirms that children with Medicaid or CHIP have dental coverage, but this protection disappears the moment they become adults. Adult dental benefits are currently determined at the state level, with wide variability. Four states do not cover dental care, and only eight cover enough care to be considered comprehensive. “When states do not have a dental benefit, Medicaid programs still pay the price for avoidable emergency department visits for dental problems. Additionally, adult dental care is constantly threatened in times of budget shortfalls due to its ‘optional’ nature,” he added.
Simon noted that organized dentistry has repeatedly lobbied against these coverage changes. “Their lobbying protects the financial interests of dentists as small business owners, not the oral health of patients and communities.”
In general, dentistry has been unable or unwilling to change to meet the needs of more Americans, Simon said. “Change will have to come from outside. Both my medical and dental patients have asked me the same question: why is dentistry so separate? Why is it so difficult for me to access and pay for dental care? I tell you there is no good reason. There is no good reason we live in a country where low-income Americans are 16 times more likely to lose all their teeth than their wealthier neighbors. It’s just not fair. My patients deserve better. “Our country deserves better.”
Myechia Minter-Jordan, MD, MBA, president and CEO of CareQuest Institute for Oral Health, also provided written testimony. She described how she had previously served as medical director and CEO of the Dimock Center, one of the largest community health centers in Massachusetts.
While in Dimock, she witnessed the devastating consequences of oral disease on children in the Head Start/Early Head Start program. The severity of the disease experienced by these young participants (some as young as three years old) meant that these children were sedated with anesthesia to perform the level of restorative care necessary to eliminate cavities and stop the progression of the disease. “That was a moment of reckoning for me. It was unacceptable that a preventable disease affected our children in this way. This experience is what ultimately led me to work at CareQuest Institute,” Minter-Jordan said.
The fact that dental coverage and care remains largely separate from medical care has had a profound impact on affordability and access to services, he explained. Millions of people across the country cannot access the oral health care they need, in most cases because they cannot afford it. In fact, dental care is the number one medical service skipped due to cost, even more so than prescription medications.
Nearly 70 million adults and nearly 8 million children in the United States do not have dental insurance. This is in part because traditional Medicare does not cover dental services except in very specific and extreme circumstances. As a result, half of all Medicare enrollees do not have dental coverage, meaning nearly 25 million older Americans and people with disabilities lack access to this critical form of health care. About the same number of Medicare enrollees have not visited a dentist in 12 months. While people who have Medicare Advantage can get some dental coverage, benefits can vary widely from plan to plan and can come with limited provider networks, Minter-Jordan said.
The lack of dental coverage options exacerbates the national oral health crisis and forces many people to forgo critical dental care, leading to deep inequities in access and outcomes, she explained. “Addressing these gaps is a critical and critical step toward achieving a health system that prioritizes prevention, strengthens the oral health workforce, integrates medical and dental care, and improves health information sharing between medical and dental providers.”
