By Mary Otto
Acknowledging that millions of Medicare beneficiaries have unmet oral health care needs, a diverse coalition of organizations, including Families USA, the American Dental Association, and the Santa Fe Group recently collaborated to study the idea of adding dental coverage to the program. Their white paper lays out a plan to add preventive and restorative dental services to the menu of medically necessary outpatient services covered under Medicare Part B.
Under the group’s scenario, a comprehensive dental benefit without dollar-value caps would cost the federal government $32.3 billion in the current year and raise the base premium for Part B benefits by an estimated $14.50 per month.
But dental coverage is not the only important benefit left out of Medicare. The program also largely excludes vision and hearing services, other analysts have observed.
“Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year,” noted authors of a 2018 issue brief for the Commonwealth Fund. The paper outlines a plan for a voluntary supplemental benefit for Medicare that would combine coverage for routine dental, hearing and vision services.
The benefit, which would be administered by Medicare, could cover preventive care visits at a total cost of $1.924 billion per year, paid for by $25 monthly premiums, according to the authors.
By their calculations, the benefit could insure nearly 9 million Medicare beneficiaries if the policy included subsidies for people with low incomes.
Efforts to make such reforms have included Vermont Sen. Bernie Sanders’ Comprehensive Dental Reform Act of 2015 (which would have added a dental benefit to Medicare, among other changes) and the Medicare Dental, Vision, and Hearing Act of 2016 (adding benefits to Medicare Part B), which was championed by now retired Congressman Jim McDermott of Washington state.
Those bills faltered but the ideas have not died. Sen. Benjamin Cardin of Maryland in January introduced a bill to amend the Social Security Act and add dental benefits to Medicare.
The Medical Dental Bill of 2019 would expand Part B to include coverage of oral health and dental services ranging from preventive visits to restorative procedures, dentures and emergency care.
Then there is the sweeping Medicare for All Act of 2019, unveiled this spring by more than 100 House Democrats, including U.S. Rep. Pramila Jayapal of Washington state.
“Jayapal’s Medicare-for-all would move every American onto one government insurer in two years,” noted Jeff Stein, in a story for the Washington Post. “Similar proposals have been projected to increase federal expenditures by at least $30 trillion but virtually eradicate individuals’ health spending by eliminating payments such as premiums and deductibles.”
Moreover, the sponsors say, the coverage would include vision, hearing and dental care.
