A look at 4 ways to grow dental coverage in Medicare

Brushing teeth toothbrush oral health dentist
A new report examines a number of strategies to expand dental coverage in Medicare. (Getty/CentralITAlliance)

Policymakers could take several avenues toward expanding options for dental care in Medicare, according to a new analysis.

Analysts at the Kaiser Family Foundation (KFF) dived into several possibilities for increasing Medicare beneficiaries’ access to oral care including adding dental coverage to Part B, creating a new voluntary dental benefit in Medicare, using regulatory authority to grow access to dental care and providing discount cards to beneficiaries. 

Though oral health is a key factor in overall health, relatively few Medicare beneficiaries are covered for dentistry.

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But it would behoove lawmakers to pay attention. A KFF report from earlier this year found that two-thirds lack access to dental care. And expanding coverage is popular, with a Families USA poll finding 70% support growing Medicare’s dental coverage

“Lack of dental coverage means dental care is out of reach for many beneficiaries who cannot afford to pay out-of-pocket for their care,” the researchers wrote. 

RELATED: The missing piece in telemedicine? Dentistry 

Each option has pros and cons, the researchers said, and making to changes to Part B or adding an entirely new benefit would be more laborious, as doing do would require an act of Congress. Here’s more from their analysis: 

Providing dental coverage through Part B 

If Congress elected to modify Part B to cover dental care, it would have to address several key concerns in the benefit design, starting with just how extensive the benefits would be. Coverage varies widely today between Medicare Advantage, Medicaid and private plans. 

One strategy would be to take after the original design of Medicare Part D, with a “doughnut” model. In this approach, Medicare would cover preventive and catastrophic services, with beneficiaries covering the “doughnut hole” between themselves. Part D’s “doughnut hole” was not popular, and the program has been modified since. 

Policymakers would also have to develop a physician fee schedule that works to determine reimbursements, according to the report. Taking this approach would also likely boost Medicare costs significantly, the analysts said. 

Launching a new voluntary benefit 

Developing a new voluntary benefit for dental care would also be a way Congress could take a cue from Part D, the analysts said. This approach would run into similar concerns as rolling oral care into Part B, requiring policymakers to carefully consider the scope of benefits and reimbursement. 

RELATED: MedPAC—Tweaks to Part D plan design chip away at payers’ incentives to keep costs down 

Another key decision: Who would administer the plan, the government or private payers? Or would legislators use a combination of both? Closely modeling a dental benefit after Part D could introduce market pressures to drive down costs but could still increase Medicare spending, the researchers said. 

“Based on the available evidence, it is unclear whether private plans or a government-administered dental benefit would lead to lower prices and lower Medicare spending,” the researchers said. 

Expanding dental benefits without Congress 

If the Centers for Medicare & Medicaid Services (CMS) chose to expand dental benefits on their own, the million-dollar question would be to what extent they can do so. This is a matter being discussed by the administration today, the researchers noted. 

The key would be finding a definition of “medically necessary” dental care that avoids stepping into Congress’s territory, they said. CMS could potentially opt, for example, to provide dental care to people with certain chronic illnesses. 

Using regulation to expand dental benefits would require policymakers to consider many of the same concerns as a broader change but would reach a more limited population, the analysts said. 

Offering discount cards for dental care 

CMS could look to drug discount cards as a model to mitigate the cost of dental care for beneficiaries, according to the report. This would reach a relatively broad swath of the Medicare population. 

The challenge, the KFF researchers said, would be in ensuring the card works for low-income beneficiaries. This would also be a model that drives up costs in Medicare but could be designed in a way to limit those cost increases, they said. 

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