Adding an Oral Health Benefit to Medicare

Background on oral health coverage in Medicare:
When the Medicare Program was created in 1965, the major connection between oral health and overall wellness was not as well understood, and the Program excluded coverage of medically necessary dental care. While the connection between oral health and overall health outcomes is now proven, many people who rely on Medicare have limited access, or no access, to dental care.

Impact:
Florida has over four (4) million Medicare beneficiaries.1 Many are on a fixed income. Although some Medicare beneficiaries have a limited dental benefit through their enrollment in a Medicare managed care plan, the coverage provided under those plans is limited, does not include all medically necessary dental care, and is costly for anything other than basic services like cleanings. While Florida took a huge step forward in expanding adult dental services for Medicaid recipients, most Medicare beneficiaries do not qualify for Florida’s limited Medicaid program.

Although the American Dental Association recommends at least one visit per year, almost half of all Medicare beneficiaries did not have a dental visit in 2016 and even higher rates were reported among those who are black or Hispanic, have low incomes, have poor health, and live in rural areas. Over 68% of elderly individuals suffer from periodontal disease which can lead to other health complications. Finally, it is now well established that poor oral health is linked to diabetes, heart diseases and other worsened health outcomes, particularly for the elderly who are at increased risk for these serious health conditions.2

Status:
Given the now well-understood importance of covering oral health care for Medicare beneficiaries, there are multiple efforts at the national level to address the need. These efforts include a bi-partisan administrative request, two Senate bills, and three House bills. Each is described below:

1) Bi-partisan administrative request
A bi-partisan request by members of Congress to the federal Agency that administers Medicare, the Centers for Medicare and Medicaid Services (CMS), has been submitted. Significantly, this request would not require a change to the law. Instead, it would provide a path to affordable dental care because CMS can authorize coverage for medically necessary dental benefits in limited circumstances where oral disease affects another Medicare-covered condition; for example, when oral infection prevents someone from safely undergoing surgery for another condition. While not comprehensive coverage, if adopted, this would provide dental services to those whose health is at most risk if the dental services are not provided.

A copy of the most recent bi-partisan request in the House of Representatives from September 17, 2018 is linked here. The most recent bi-partisan request in the Senate from September 20, 2018 is linked here.

Those leading this effort, including Representative Gus Bilirakis from Florida’s 12th Congressional District, underscore the need for bipartisanship. The plan for moving forward with this request is that for each Republican who signs on, there will be a Democratic signee, and vice versa. Continued pressure from Congress is necessary to keep this effort moving forward.

2) Senate bill: The Medicare Dental Benefit Act of 2019, S. 22
Senator Benjamin Cardin introduced the first major legislation that would provide for inclusion of a comprehensive dental benefit in Medicare Part B. Leading national advocacy groups sent a letter of support clearly spelling out the benefits of including a dental benefit in Medicare.

3) Companion House Bill: The Medicare Dental Benefit Act of 2019, H.R. 2951
Representative Nanette Diaz Barragán introduced this companion bill and the bill is supported by leading advocacy groups such as Families USA, American Association of Public Health Dentistry, American Dental Hygienists’ Association, Center for Medicare Advocacy, Children’s Dental Health Project, Community Catalyst, Justice in Aging, National Dental Association and the Santa Fe Group.

4) House Bill: Medicare Dental, Vision, and Hearing Benefit Act of 2019, H.R. 1393
Representative Lloyd Doggett introduced the bill to amend title XVIII of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare program. The bill was introduced in February of 2019.

5) House Bill: Seniors Have Eyes, Ears, and Teeth Act, H.R. 576
Representative Lucille Roybal-Allard introduced this bill to expand Medicare coverage to include eyeglasses, hearing aids, and dental care. Introduced in January of 2019, the bill has been referred to the Subcommittee on Health.

6) Senate Bill: Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019, S. 1423
Senator Robert Casey, Jr. introduced this bill to amend titles XVIII and XIX of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs. The bill was introduced in May of 2019 and has been referred to the Committee on Finance.

Next Steps:
Oral health is an important part of health care, and until Medicare includes an oral health benefit, beneficiaries will continue to suffer. If you or a loved one has been impacted by the lack of dental coverage, we want to hear from you. Through the Florida Health Justice Project STORIES initiative, we will work with you in sharing your “story” with national leaders in oral health advocacy, including Justice in Aging and Families U.S.A.3

The work on this brief was supported through funding from The Florida Bar Foundation and Catalyst Miami.