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 Retirees transitioning to Medicare are often surprised to learn that
the program does not cover routine dental care or more complex
procedures.
Overall, 40 percent of the 65-plus population has some form of
dental benefit, according to the National Association of Dental
Plans. For seniors who use Medicare Advantage managed care plans,
about half offer very limited coverage for cleanings and exams. A
small percentage of seniors have dental insurance from a former
employer, and Medicaid covers dental care for low-income residents
in some states, although benefits vary. Some buy individual
commercial plans or have coverage through an association such as
AARP.
But most seniors just pay for dental care out of pocket - the mean
expense for Americans age 65 and older was $870 in 2012, according
to the Agency for Healthcare Research and Quality, a research arm of
the U.S. Department of Health and Human Services.
The costs can be far higher for more complex procedures. The average
cost of a crown in New York City is $2,500; a periodontal procedure
in Los Angeles costs $1,700, according to Fairhealthconsumer.org, a
service that tracks prices of healthcare and health insurance.
Those numbers help explain why 34 percent of seniors had not seen a
dentist in two years in 2010, and 22 percent had gone without care
for the past five years, according to the Kaiser Family Foundation (KFF).
“Dental care is conspicuously absent from the health care coverage
for older adults,” says Dora Fisher, director of older adult
programs at Oral Care America, a nonprofit group that advocates for
better oral health.
Medicare celebrates its 50th anniversary later this month, and
adding basic dental coverage is on the wish list of many health
policy experts reflecting on the program’s future.
Research shows clear links between poor oral health, diabetes and
heart disease. One out of four Medicare beneficiaries has edentulism
- that is, they no longer have any of their natural teeth, according
to KFF; that can cause other health issues, such as nutritional
deficiencies and problems with speech.
PRICING OPTIONS
Premiums for private plans, are reasonable - PPO plans cost around
$15 per month, Ireland says. But individual coverage is not as
robust as group dental plans. “Most have waiting periods before
coverage for major procedures begins, and the dollar caps on
coverage may be lower,” she says.
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Ireland adds that dental insurers have been negotiating with the
federal government to offer individual standalone dental plans
(independent of health insurance) through the Affordable Care Act
insurance exchanges, and she hopes expanded offerings will start
showing up in 2016 or 2017.
Dental plans are available on many exchanges now, but they can only
be purchased along with general health insurance. That effectively
cuts out seniors, who are covered by Medicare.
Consumer advocates are pushing for Medicare to pay for dental care
made necessary by other procedures that the program does cover. The
Center for Medicare Advocacy (CMA), a non-profit legal organization,
has filed lawsuits on behalf of cancer patients who have been denied
coverage for dental procedures made necessary due to aggressive
radiation of the head and neck.
“Medicare covers what happens to the patient’s eyes even though it
doesn’t provide routine eye care - but there’s no coverage for this
type of extreme dental care, and people are ending up in the
hospital with infections,” says Margaret Murphy, an associate
director and attorney with CMA. The Centers for Medicare and
Medicaid Services did not respond to requests for comment.
The litigation has not been successful so far, but CMA has not given
up. “We’re trying to figure out where to go with it next,” Murphy
says.
(Editing by Beth Pinsker and Lisa Shumaker)
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