WASHINGTON — At a hearing last Thursday, dentists from across the country urged Congress to include dental insurance in Medicare, saying less than half of beneficiaries visit a dentist each year.
A panel of four dentists told the U.S. Senate Committee on Aid, Education, Labor and Pensions that other changes are also needed to narrow the gap in consistent dental care for all Americans, including removing the barrier between health care and dentistry, as well as increasing the affordability of treatment underserved communities.
Dentists also told senators that better outreach and education is needed so people understand how missing regular check-ups can negatively impact their physical health.
Dr. Lisa Simon, an associate physician at Brigham and Women’s Hospital and a faculty member at Harvard Medical School, testified that “fewer than half of Medicare beneficiaries visit a dentist each year. When they do this, they spend over $1,000 out of pocket on care.”
She also told senators this during hearing that the dental coverage offered by many Medicare Advantage plans is inadequate. Such plans offered by private companies include Part A and Part B coverage and often include drug coverage.
“Dental plans often attract beneficiaries who choose Medicare Advantage,” Simon said. “But my research has shown that Medicare Advantage beneficiaries have just as low rates for dental access and out-of-pocket costs are just as high as traditional Medicare beneficiaries. “Medicare Advantage is not the answer here.”
Dr. Myechia Minter-Jordan, president and CEO of the CareQuest Institute for Oral Health in Boston, told the panel that Medicare’s time-honored exclusion of dental benefits leaves about “half of Medicare enrollees, nearly 25 million older Americans and people with disabilities, without dental services.
“There is currently no financial support for adults to purchase dental insurance through the Health Insurance Marketplace,” Minter-Jordan said. “And dental coverage for adults is optional under state Medicaid programs, which means coverage varies widely, from extensive coverage to none at all.”
Dr. Brian Jeffrey Swann, who serves on the board of Remote Area Medical and has a dental practice in Tennessee, told the committee that the nonprofit organization provides dental and vision clinics for uninsured and underinsured people.
“People who come to RAM for help often drive across two or three state lines, sleeping in cars, wrapped in blankets for warmth. Many people come in a few days before the clinic to make sure they get a ticket,” Swann said.
“Patients suffer from tooth decay and gum disease,” he added. “This is concerning because of the interplay between gum disease and diabetes.”
Swann, who also serves as co-chair of Global Oral Health at the National Dental Association, said the organization has been calling for the inclusion of dental insurance in Medicare for decades.
Sanders and Cassidy split on changes to Medicare
The dentists’ recommendations revealed a rift between the two top lawmakers on the panel.
“The lack of affordable dental care in America is a national problem,” said HELP Committee Chairman Bernie Sanders, a Vermont independent. “But it is particularly acute for lower-income Americans, pregnant women, people with disabilities, veterans, people living in rural communities, as well as Blacks, Latinos and Native Americans.”
Sanders stated that dental care access and affordability in the United States “has become so absurd” that Americans have started traveling to “countries like Mexico, Costa Rica, India, Thailand and Hungary where dental care is much cheaper.” they need.”
This is still out of reach for many people, and as a result, nearly 1 in 5 seniors lose their teeth, he said.
“Many of them cannot afford dentures, which can cost many thousands of dollars,” Sanders said, adding that “70% of older Americans have some form of periodontal disease, which can lead to rheumatoid arthritis and cardiovascular disease.”
Sanders said, as he has for years, that Medicare should include dental and vision coverage.
Louisiana Republican Senator Bill Cassidy, a member of the HELP committee, said that about “88% of Americans have dental insurance,” although he noted that “the pent-up demand for dental care is greater than the pent-up demand for medical care.”
Doctor Cassidy said that while time-honored Medicare does not cover dental procedures, about “98% of Medicare Advantage plans offer dental benefits, and more than half of Medicare beneficiaries are covered by an MA plan.”
He appeared to dismiss the proposal to add dental coverage to Medicare in the near future, noting that the program would experience a significant funding shortfall within about 10 years.
“With Medicare on track for insolvency in just over a decade, we should also think about ensuring sustainability before adding programs to it,” he said.
Cassidy also criticized the way Medicaid, the program that provides health insurance to low-income people, currently approaches dental care.
“The reimbursement rate under Medicaid is so paltry that, frankly, it creates the illusion of coverage without access,” Cassidy said. “If you lose money on every Medicaid patient you encounter, you can’t make it up.”
Problems of rural America
During the hearing, Republican Senator Lisa Murkowski of Alaska raised the issue of access to dentists in rural areas, including her home state.
“I grew up in a part of the state where if you needed to go to the dentist, you got on a plane or a ferry and usually went to Seattle,” she said. “And it wasn’t a cheap trip, but it was a way for us to get health care.”
“We have improved significantly since then, but we still have too many communities where access is a problem,” Murkowski added.
There are still many examples where “overall health outcomes have been negatively impacted because it started with poor oral hygiene,” she said.
Dr. Gordon Roswell Isbell III, a former board member of the Alabama Academy of General Dentistry, said the challenge is ensuring there are enough dentists and dental hygienists in rural areas. He suggested developing programs that would allow dentists to move into rural areas.
“I know in our state we have worked hard on this and have had some success,” Isbell said, adding that rural residents “deserve” good dental care.
Swann testified that dental schools need more role models who can show students the best ways to live and work in rural areas. He also suggested providing incentives and “innovative business models.”
Minter-Jordan found that one-third of rural residents do not have dental insurance and 4 in 10 adults in rural areas have not visited a dentist in more than a year.
New Hampshire Democratic Sen. Maggie Hassan said during a hearing that although her home state expanded Medicaid coverage to include dental care last year, she has heard from many people that it is extremely tough to find a dentist in rural areas who is accepting recent patients and taking Medicaid.
Simon said recruiting dental students from rural areas “may go a long way toward improving service to these communities.”
