As the country’s largest public health program, Medicare is critical for the health and wellbeing of almost 64 million older adults and people with disabilities. Unfortunately, Medicare does not include a comprehensive dental benefit. However, there are limited options for people to get coverage for dental care when it is considered “medically necessary.” This summer, the Centers for Medicare and Medicaid Services (CMS) proposed some updates to coverage of “medically necessary” dental care, including expanding the types of medical services that would trigger coverage of dental care. Community Catalyst commented in support of these changes, acknowledging that any expansion of coverage for people with Medicare – who are largely left out of access to dental care – is critical.
However, CMS’s proposal is narrow and still only allows for payment of dental services when they are “inextricably linked to, and substantially related and integral to, the clinical success of other covered medical services.” Regular dental care remains largely uncovered for millions of older adults and people with disabilities covered by Medicare, exemplifying a larger problem with our country’s health care system – peoples’ oral health is routinely separated from the rest of their health and wellbeing.
This separation makes little sense, given well-documented evidence that oral health is inextricably linked to long-term physical health, other chronic conditions, and mental wellbeing. Critically, oral health is also an economic justice issue. Dental care presents the highest financial burden of any health care service, which isn’t surprising given that nearly 40% of dental care costs are paid out of pocket. Relatedly, dental debt contributes to broader medical debt for about half of adults who have it. Due to structural racism and resultant long-standing economic inequities, people of color are more likely to have debt as a result of dental or other medical bills and face greater barriers to accessing dental care in general.
While CMS doesn’t have the authority to fix this longstanding problem via rulemaking, there are opportunities to improve access to care and oral health for all. Most recently, Congress had the opportunity to make comprehensive oral health coverage a component of both Medicare and Medicaid as part of the Build Back Better Act. Because of longstanding inequities, this would have supported BIPOC communities, especially those living at the intersections of low-income and disability – the most. While this didn’t make it into the final package, advocates can continue to encourage Congress to prioritize this critical aspect of care in future health reform efforts, from adding a comprehensive dental benefit to Medicare to standardizing and mandating coverage for adults with Medicaid.