Lack of routine dental care can result in complications and high-cost emergency department visits. Yet almost two-thirds of Medicare recipients, 37 million people, don’t have dental coverage, according to a recent report from the Kaiser Family Foundation (KFF).
As a result of not having coverage, 49% of those surveyed said they had not been to the dentist in the past year. And for those that did see a dentist, 19% spent more than $1,000 out of pocket.
Specifically by demographic, 71% of black Medicare recipients, 65% of Hispanic Medicare recipients, 70% of low-income enrollees and 59% of those living in rural areas did not have a dental visit over the past year.
"We were surprised that 49% of all people on Medicare did not see a dentist in the past year, even knowing that nearly two-thirds of all people on Medicare have no dental coverage, but we were stunned how high the numbers were for black and Hispanic beneficiaries, and what that means for their oral health care," Meredith Freed, a policy analyst for KFF's Program on Medicare Policy, told FierceHealthcare.
The survey also spotlighted the strong connection between oral health and overall health. More than 6 in 10 of those surveyed who reported themselves in fair or poor health did not go to the dentist in the past year, compared with 37% who said they were in excellent or very good health.
In addition, 62% of people under the age of 65 but with a disability went without a dental visit in the past year.
Cost was the big driver for avoiding care. Overall, 10% of those surveyed did not get dental care because of the cost. Other reasons for not going included fear, inconvenient location or time for an appointment. And for the older demographic, hurdles include transportation challenges, lack of professionals, and health literacy issues. In fact, transportation disproportionately affects older adults and those living in rural areas with low incomes.
In 2016, the average out-of-pocket dental care cost was $469. With half of Medicare beneficiaries living on less than $26,200 per year, out-of-pocket costs can be significant. Only 11% of those surveyed used dental services without any out-of-pocket costs.
Plus, of adults 65 and over, 15% have no natural teeth. Even higher, almost one in three of those with incomes below 100% of the federal poverty level have no natural teeth. And not having any natural teeth correlates with many health conditions including lack of nutrition and periodontal disease. As a result, more than 2 million visits to the emergency department per year are for people with an oral health complication.
So what is the holdup? Freed says that dentists originally resisted the idea of being included in Medicare and subject to a fee schedule. But today, the biggest stumbling block is the potential cost of adding dental coverage to Medicare, and the potential implications for federal spending and beneficiary premiums.
"Medicare benefits have evolved fairly slowly over the years," Freed said. "The last big benefit improvement was for prescription drug coverage, and that happened in 2006—40 years after the program was implemented."
Since its establishment in 1965, Medicare has almost totally excluded coverage for dental services. In 2016, about 10.2 million beneficiaries (18%) had access to some dental coverage through Medicare Advantage.
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Other options for coverage include Medicaid programs. Among those with dual eligibility, 88% lived in a state where they were eligible for some dental benefits from Medicaid. But about one-tenth of dual eligibles, 800,000 people, resided in the six states that provided no dental coverage through Medicaid in 2016: Alabama, Delaware, Maryland, Tennessee, Texas and Virginia.
Dental coverage is also available from private insurers. In 2016, about 4.5 million Medicare beneficiaries received dental coverage through private plans.
Currently, the government is considering a broad array of ideas to get Medicare recipients dental coverage. For example, some are advocating for CMS to cover oral health, and others have considered a separate benefit, similar to Part D, as its own premium. In addition, a benefit could be created exclusively for low-income beneficiaries under Medicare or Medicaid.
“Thus far, the Congressional Budget Office has not estimated the cost of adding a dental benefit to Medicare. Given the significant health risks associated with poor oral care and the costs and consequences of untreated dental needs, identifying potential solutions to improve the oral health status of the Medicare population remains a challenge,” the report concludes.