House lawmakers to CMS: Expand dental coverage in Medicare now

More than 100 House lawmakers say the Centers for Medicare & Medicaid Services (CMS) has the power now to expand dental coverage.

The letter (PDF), released Thursday to CMS Administrator Chiquita Brooks-LaSure, comes as federal efforts to expand coverage of hearing and dental benefits to all Medicare beneficiaries have stalled in Congress. Lawmakers say the agency can expand the definition of “medically necessary” dental care that Medicare can currently cover.

“Our nation’s seniors deserve so much more than half measures and half health,” said Rep. Lloyd Doggett, D-Texas, one of the leaders of the effort. “An overly narrow and outmoded interpretation of the Medicare statute must be updated to account for medical evidence of oral health’s strong connection to overall health.”

Traditional Medicare does not cover dental or vision, but beneficiaries can either buy a supplemental plan or a Medicare Advantage plan to get such benefits. 

However, CMS allows coverage of dental services that are an “integral part either of a covered procedure” like a jaw reconstruction. Medicare will also pay for extractions in preparation for radiation treatment on the jaw, the letter to CMS said. 

But the lawmakers contend CMS can expand that authority to include dental service coverage in several scenarios such as if oral or dental bacteria are an underlying cause of a disease like Parkinson’s or stroke outcomes are worsened by dental infections. 

Other examples include coverage for dental services if the beneficiary is being treated for cancer and leukopenia from chemotherapy “increases the risk of dentally sourced bacteria causing sepsis or other serious complications,” the letter said. 

A 2021 analysis from the Urban Institute found dental visits increase with age, as the number of dental visits double by 60 years old. In addition, only 27% of Medicare enrollees’ dental costs get covered by insurance, and nearly 10% pay more than $1,000 in out-of-pocket costs a year.

The request to CMS comes as Congress appears unlikely to add dental benefits to traditional Medicare. The Build Back Better Act initially proposed including dental, hearing and vision benefits for all beneficiaries, but that proposal was dropped after the $3.5 trillion price tag was declined. A pared-down version passed the House but has stalled in the Senate.

CMS did not immediately return a request for comment as of press time.