Dental care is healthcare, too, but Medicare doesn’t cover it. That has to change | Editorial [Miami Herald]

Miami Herald (FL)

As anyone who has ever had a root canal or an impacted tooth can tell you, dental care is a medical necessity. And yet Medicare, the public insurance program for people 65 and older and those with permanent disabilities, doesn’t cover dental care — and never has.

That defies common sense, especially as healthcare professionals increasingly emphasize the links between oral health and overall health, including connections with diabetes and heart disease. So it was encouraging that the discussion in Washington about expanding Medicare, as contemplated under President Biden’s Build Back Better spending plan, included adding hearing, vision and dental coverage. For Florida’s 4.6 million Medicare recipients — the second-highest number in the country after California — this is more than a theoretical debate; it’s a pocketbook issue.

The latest framework for the plan issued by the White House cut the price of the spending package significantly after negotiations with moderate and progressive Democrats and didn’t include dental or vision care, though it did include coverage for hearing services for the first time. Advocates are still hoping they can get dental coverage in a final agreement.

The idea is facing some serious headwinds from the American Dental Association, insurance companies and others. Among the objections being raised in Washington: worries that Medicare won’t reimburse dentists at a high enough rate and the high cost attached to expansion. For dental coverage alone, the cost is an estimated $238 billion over 10 years to cover all beneficiaries.

Another consideration: Many Medicare Advantage plans — the private version of Medicare — already provide some form of dental coverage.

The American Dental Association has floated a suggestion that expansion might cover only lower-income seniors. The ADA, in a statement about expansion, noted that the percentage of Medicare-eligible seniors who have faced cost barriers to getting care is on the rise, especially those who are lower income. It said that, “Any expansion of Medicare should include a separate new program dedicated to providing comprehensive dental care for low-income seniors.”

Other groups, like the AARP, believe Medicare’s basic benefits should be expanded to cover all three things: dental, vision and hearing. They’re encouraged by the amount of attention being focused on expansion, which they say is long overdue.

“It finally seems to have reached a groundswell of support and recognition that this is a problem that needs to be addressed for older Americans,” Andrew Scholnick, senior legislative representative for AARP, told the Editorial Board.

Dentistry has long been considered separate from the rest of the medical system. And once Medicare began in 1965 — minus any dental benefits — the divide became the norm. But these days, dental bills can cost thousands, and for fixed-income seniors especially, that can lead to postponing care until it’s a crisis. Emergency rooms aren’t the answer, either, because they rarely can provide dental care.

Medicare Advantage plans offer some people a solutions but they aren’t without their own issues. The plans, the fast-growing managed-care alternative to “straight” Medicare, are run mostly by major insurance companies and offer benefits such as eyeglasses, gym memberships — and dental care. The plans are very popular in Florida, no place more so than Miami-Dade, Broward and Palm Beach counties, where more than 50% of beneficiaries are enrolled in a Medicare Advantage plan.

And yet Medicare Advantage plans cost the federal government more than Medicare — though they were originally billed as a cost-saving alternative — and that has been raising alarms in Washington. They also offer smaller networks of doctors and hospitals than Medicare. And Scholnick points out that their dental coverage varies greatly by plan and often is skimpy.

In other words, Medicare Advantage plans aren’t for everyone — and they shouldn’t be considered the solution to Medicare’s lack of dental benefits.

Medicare should be able to provide a medical — and financial — safety net for older Americans. And that means including dental benefits across the board, not just for low-income seniors.

After all, this isn’t charity. Seniors paid into the system for years. They’re entitled to dental coverage as part of the Medicare.