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Medicare Dental: Time To Fill In The Gaps

dental

Traditional Medicare doesn’t cover most dental care, or eye exams, or dentures, or hearing aids, or foot care exams.

By Al Norman

If you look in your Medicare & You Handbook for 2020 on page 49 you’ll find this admission: “Medicare Doesn’t Cover Everything.” Right under that you will see that Traditional Medicare doesn’t cover most dental care, or eye exams, or dentures, or hearing aids, or foot care exams (except for diabetes-related damage).

Routine dental services, for example, are excluded from Medicare coverage under current law except when the patient’s condition requires inpatient hospitalization for dental services otherwise excluded from coverage.

socialWhen I joined Medicare several years ago, I opted for a “Medicare Advantage” plan — managed care plans which offer benefits beyond Traditional Medicare. I added a separate “Dental 65” plan offered by the same Medicare Advantage plan in Massachusetts. My Advantage plan has been pretty good for medical coverage — but the Dental plan sold as a supplement has been a major disappointment. It had a 6 month waiting period — during which I had to pay $216 in premiums in return for no benefits.

It also charged me a deductible — twice within one calendar year — because I started coverage in February, 2018, paid a deductible that month, and again in January, 2019.

Curious to see how much my plan paid in benefits vs. how much I paid in premiums and copays, I asked my plan to send me a “Claims Listing,” which showed I had been charged $2,689 in dental bills, of which $446.13 had been paid to me in benefits, or 16.6 percent of total bill. I paid $1,235.06 in copays, deductibles, and premiums.  For every $1 I got in benefits, I paid $2.77 in premiums, deductibles and copays. This is how my health insurance plan has purchased such expensive offices in Boston.

But I consider myself lucky. An analysis by the Kaiser Family Foundation (KFF) last March found that almost two-thirds of Medicare recipients, 37 million people, don’t have dental coverage at all. Almost half (49 percent) of those surveyed said they hadn’t seen a dentist in the past year, and of those that did see a dentist, 19 percent spent more than $1,000 out of pocket. “Lack of dental care can exacerbate chronic medical conditions,” the KFF wrote, “such as diabetes and cardiovascular disease, contribute to delayed diagnosis of serious medical conditions, and lead to preventable complications that sometimes result in costly emergency room visits.”

The Medicare statute could be amended to allow dental services to be covered under Medicare Part B.

A few weeks ago the KFF published a list of policy options to make Medicare better at dental care. The Medicare statute could be amended to allow those services to be covered under Medicare Part B. All Part B enrollees would be entitled to Medicare-covered dental services, just as they are covered for physician care and other defined outpatient services.

One approach, says KFF, “could provide a comprehensive dental benefit that covers preventive services such as cleanings and x-rays, basic procedures such as fillings and extractions, and more extensive (and expensive) treatments, such as crowns, dentures, and implants. This approach would be parallel to the comprehensive nature of Part B medical benefits.” If Part B is expanded to include a  benefit, about 10 million low-income beneficiaries who are dually eligible for Medicare and Medicaid would have their premiums for the new Part B dental benefit automatically paid on their behalf by Medicaid through the Medicare Savings Programs,

KFF says a dental benefit under Part B has the advantage of using a structure in place, rather than setting up a new and separate part of Medicare that would require its own set of rules. “Unlike a new voluntary, stand-alone dental benefit, a Part B benefit would be relatively straightforward for beneficiaries because dental services would be integrated seamlessly with other covered medical benefits.”

Another option for strengthening dental coverage under Medicare would be to create a new, separate voluntary dental benefit, similar to the way prescription drugs were added under Medicare Part D. Congress would also have to make a number of policy decisions, such as the scope of benefits, premiums and cost-sharing requirements, payment rates to providers (or plans), provider participation, and spillover effects on other sources of dental coverage.

If nothing is done, KFF warns, “untreated oral health issues can negatively impact qualify of life, lead to serious health complications, and can exacerbate certain chronic conditions and diseases such as diabetes and cardiovascular disease. Lack of oral health care can also delay diagnosis of certain physical health conditions and result in costly emergency room visits…Most beneficiaries do not have any dental coverage at all. Lack of dental coverage means that dental care is out of reach for many beneficiaries who cannot afford to pay out-of-pocket for their care.”

Send this column to your Representative and Senators in Congress, and tell them its time to look into the mouth of our Medicare dental care crisis, and fill in the gaps.

Al Norman worked in the elder home care system in Massachusetts for 38 years. He can be reached at: alnormaneldercare@gmail.com.

 

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