ADA: Focus Medicare Dental Benefit Efforts on Those Who Need it Most—Low-income Seniors

CHICAGO, August 12, 2021 — The American Dental Association (ADA) remains committed to addressing the oral health needs of all Americans – including older Americans – and is engaging with multiple stakeholders who are working together on the next steps in this national dental policy conversation.  There are multiple proposals introduced in Congress, and we are reviewing each one to assess whether the oral health needs of the most vulnerable seniors are addressed in the most appropriate and equitable way. To date, none of those proposals focuses on where the need for care is most critical – low income seniors. The ADA believes expansion of any public program such as Medicare should:

• Include a range of services necessary to achieve and maintain oral health for beneficiaries whose income is up to 300% of the federal poverty level.
• Is sufficiently funded and efficiently administered to ensure access to care.

Applying Medicare Resources to Those Seniors Who Most Need Assistance
Proposals to expand Medicare should include a comprehensive dental benefit that meets the needs of those beneficiaries up to 300% of the federal poverty level (FPL). Estimates show that meeting the needs of beneficiaries up to 300% of the FPL covers about 47% of the older adult population. This would provide meaningful coverage to most seniors who presently do not visit a dentist because they cannot afford it.

The percent of Medicare eligible seniors who have experienced increased cost barriers to dental care steadily rose from 2009-2019. Seniors with incomes at or below 133% of the federal poverty level saw the largest increase in cost barriers from 10% in 2009 to 26% in 2019. 

Creation of a New, Separate Program for Dental Benefits
The current Medicare program includes distinct “parts” recognizing the variability in delivery of health care services such as hospital care, physician services and prescription drugs. The dental care system is significantly different from the medical care delivery system and therefore merits a designated program recognizing those differences in the delivery of services if added to the Medicare program.

The ADA believes that any expansion of Medicare should include a separate new program dedicated to providing comprehensive dental care for low income seniors.

Caring for the oral health needs of seniors is complex. We hope that an innovative approach that is adequately funded and efficiently administered and which utilizes private, non-profit and government solutions will provide a workable solution and offer opportunities for improved oral health for whom the need for care is most critical – low income seniors.

Full text of the ADA’s official policy recommendations are available.

Editor’s Note: Reporters are invited to follow the ADA on Twitter @AmerDentalAssn

The not-for-profit ADA is the nation's largest dental association, representing 161,000 dentist members. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. For more information about the ADA, visit ADA.org. For more information on oral health, including prevention, care and treatment of dental disease, visit the ADA's consumer website MouthHealthy.org.