Home Caregiver Support Caregiving Issues Expanded Medicare and Dental Coverage: A Crisis Looming

Expanded Medicare and Dental Coverage: A Crisis Looming

senior man looking at the x-ray result

Expanded Medicare and Dental Coverage is needed to address the health care crisis that is looming.

As policymakers think about proposals to slash successful and effective community programs including Medicare and Medicaid, older Americans and their families continue to deal with obstacles to necessary health and wellness  care, consisting of access to dental coverage  and services. A brand-new report from Oral Health America highlights this growing dental crisis for older Americans.

According to the report lack of affordable dental coverage options, service providers and shortages, and absence of preventive programs in communities throughout the country are developing significant hardship  for older adults. Present policy choices to improve gain access to dental coverage combined with community outreach and education, would enhance public health and wellness while mirroring overall wellness care reform efforts to improve care, enhance health, and lower long-term expenses by investing in preventive care.

Growing Senior Population Lacks Dental Coverage

Despite enhancements in dental health care for the general population in the previous 50 years, older Americans still deal with a high risk of oral or dental disease. The problem is most likely to grow as the baby-boomer generation enters retirement: only 2 % of boomers who retire do so with access to dental insurance coverage benefits through their former employers or private market dental plans.

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Lack of dental insurance coverage is a major barrier to seeking dental care for aging seniors. Nearly 70 % of older Americans currently have no form of dental insurance coverage. Older adults with dental insurance are 2.5 times more likely to go to see the dentist on a routine basis. Private insurance coverage, however, continues to be costly, while coverage for low-income adults on Medicaid is optional for  most states and  dental services are restricted in those that do provide it.

Forty-two percent of  the states provide no dental benefit or only emergency coverage through adult Medicaid services. In states where dental coverage is offered through the adult Medicaid programs, getting dental care can still be a challenge for beneficiaries due to the  very low compensation rates and service providers are not willing to take that level of compensation, so there is a shortages of providers.Lack of dental insurance coverage access is a major obstacle to dental care for the aging population.

In addition, coverage for routine dental care under Medicare– the largest health insurance coverage service provider for individuals over the age of  65 years old is virtually nonexistent. Less than 1 % of dental services are covered by Medicare.

In addition,due to the fact that that dental services are not covered under Medicare, Medigap insurance or the supplemental policy that is supposed to cover services that Medicare does not, aid or pay the out-of-pocket expenses, does not cover dental services at all.

For aging senior citizens surviving on a  fixed or low-income, the high cost of dental care discourages those who do not have insurance coverage from looking for needed treatment. A recent study exposed that aging seniors who earn less than $35,000 a year consider the expense as the primary factor to consider when deciding whether to seek care.

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In the same survey, even more than half making less than $35,000 reported not going to  a dental practitioner regularly because they do not have insurance coverage or can not afford to the costs associated with the cost of dental care. Two-thirds in the exact same income group stated that if confronted with the need for common dental treatments such as a crown, implant, or bridge, they would not be able to  receive the treatment due to cost. Aging senior citizens living at poverty level, are more than 60 % more likely to have actually lost all of their teeth compared to those with higher incomes.

Differences in race, income, and disability status also impact aging seniors when it comes to dental health and dental care. Poor dental health disproportionately takes place among racial and ethnic minorities, and as well as in aging seniors with physical and intellectual disabilities and those who are homebound or institutionalized. Aging African-American  seniors  are almost twice as likely to have periodontitis gum disease than their white counterparts.

senior-dental-bad-tooth-199x300Health Implications of Poor Dental Care   

Absence of easily accessible, cost effective dental coverage can result in negative health outcomes. Data reveals, for instance, that certain dental conditions including periodontal gum disease can increase the risk heart attacks,cardiovascular disease and strokes.

On the other hand many chronic health conditions can contribute to dental health issues, leading to additional complications like those above.

The lack of  dental coverage in the largest public insurance coverage programs  such as Medicare and Medicaid leaves individuals with few options for accessing needed dental care. Emergency room visits for dental-related problems among aging seniors over 65 years of age rose from 1 million in 1999-2000 to 2.3 million in 2009-2010.

As overall healthcare  system reforms aim to emphasize primary and preventive care and discourage costly emergency care, dental care continues to be neglected by policymakers at a time when the demand for attention is greater than ever.

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Policy Solutions

The report highlights a number of policy solutions to address the present dental crisis facing aging seniors.  Chief among them are the need for expanded coverage in Medicare and Medicaid. Further, aging seniors dental coverage and services should want to  be deemed as “essential to health benefits” under the Affordable Care Act to expand access to services for those under 65.

The report argues that individual states need a legal mandate for providing dental healthcare in Medicaid to guarantee  coverage and even more equitable service provider payment. Legislation to enact these propositions has actually been introduced in Congress, and includes:

The Comprehensive Dental Reform Act of 2013: Introduced by Senator Sanders and Schatz in the Senate, and Representatives Cummings and Schakowsky in the House. This landmark legislation is the most comprehensive dental care legislation in American history. It extends comprehensive dental coverage to all aging seniors covered by Medicare, Medicaid, and the Veterans Administration. This legislation would include dental health as an essential benefit as defined  under the Affordable Care Act.

Special Care Dentistry Act of 2011: While this legislation has actually not been reintroduced  in the current session of Congress, it would have extended dental services to millions of individuals by requiring states to provide dental health services to aging seniors, blind, or disabled individuals under the Medicaid program. The federal government would cover 100 % of the cost of this expanded program.


Strengthening community education and outreach and addressing dental service provider payments and shortage issues are crucial to addressing the dental crisis faced by aging seniors and people with disabilities. The lack of dental coverage in Medicare and Medicaid, and the expense of private insurance coverage options continue to be barriers to needed care. Solutions that address dental health and access to dental care should have to be a part of efforts to improve and update Medicare and Medicaid. The Center for Medicare Advocacy has actually fought for expanded dental coverage for Medicare beneficiaries, and continues to advocate for policy changes that improve access to affordable care for aging seniors and individuals with disabilities. Instead of  policy makers cutting Medicare, Medicaid benefits, as well as  other critical health care programs  that serve our nation’s most vulnerable individuals, policymakers need to address ways to improve public health options and update our largest insurance programs by expanding coverage and benefits, including comprehensive dental care.



“Oral Health America, State of Decay: Are Older Americans Coming of Age without Oral Healthcare?” available at  http://www.toothwisdom.org/action.
CNN, “Dental crisis could create ‘State of Decay'”,
Centers for Medicare and Medicaid Services, Chronic Conditions Among Medicare Beneficiaries, 2012 Chartbook, available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf.
Oral Health America, State of Decay.
Legislation available at http://thomas.loc.gov/cgi-bin/bdquery/z?d113:s1522 [http://thomas.loc.gov/cgi-bin/bdquery/z?d113:s1522 ]:.
Legislation available at http://thomas.loc.gov/cgi-bin/bdquery/z?d112:hr1606 [http://thomas.loc.gov/cgi-bin/bdquery/z?d112:hr1606 ]:.
Center for Medicare Advocacy, Fournier v. Leavitt, more athttp://www.medicareadvocacy.org/fournier-v-leavitt/