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Discussion abounds on adding dental benefit in Medicare

September 11, 2018

By Kelly Ganski

Adding a dental benefit within Medicare is a topic of conversation among agencies that advocate for seniors but also within the ADA.

The Council on Dental Benefit Programs, with support from the Council on Advocacy for Access and Prevention, is submitting Resolution 33 to the House of Delegates, which meets in October in Honolulu, which outlines what the council would want as an advocacy position if legislation to add a dental benefit to Medicare is introduced in Congress. This comes on the heels of the ADA’s increasing awareness of Oral Health America’s coalition of consumer advocacy groups that is beginning conversations with legislators and regulators on adding a dental benefit to Medicare.

“If the program were to be implemented, it must be designed to ensure dentists are willing to participate while taking the best care of our patients,” said Dr. Brett Kessler, member of the ADA Council on Dental Benefit Programs, which had been charged by the Board of Trustees with exploring the implications of including dentistry in Medicare. “The big questions that we face are whether the ADA should advocate for a benefit? Should the ADA do everything in its power to prevent a benefit? Should the ADA develop a policy that we try to educate or guide any entity that is trying to develop a dental benefit in Medicare to include what we think are best practices?”

The ADA evaluated the benefit design developed by the coalition then began educating the group on the Association’s perspective on benefit design, offering its own analysis on a Medicare benefit. The coalition July 20 released a white paper titled “An Oral Health Benefit in Medicare Part B, It’s Time to Include Oral Health in Health Care,” on the proposed benefit, examining need, cost and needed legislative changes.

The ADA contributed data to the white paper, but the Association's input "does not constitute endorsement of inclusion of a dental benefit under Medicare at this time," ADA President Joseph P. Crowley said in an email to members July 23.

“If we are not at the discussion table, no one will win. Not our patients, not our communities, not our practices,” Dr. Kessler said.

The Council on Dental Benefit Programs’ resolution states if legislation were introduced that would add a dental benefit to Medicare then the ADA should advocate for:

• Coverage for comprehensive services in an appropriate part within Medicare with adequate program funding.

• Reimbursement rates at or above median fees (50th percentile) as described in the current ADA Survey of Dental Fees to ensure adequate dentist participation.

• Funding for technical support for dental practice participation including adoption of health information technology standards.

• Minimal and reasonable administrative requirements for dental practice participation

• Medicare beneficiaries with the freedom to choose any dentist while continuing to receive the full Medicare benefit.

"No matter the outcome of this resolution, policy makers, legislators and members of the public look to the ADA for guidance and solutions on solving dental access issues for senior Americans,” said Dr. Tim Fagan, chair of the Council on Advocacy for Access and Prevention. “Based on the ADA vision of ‘achieving optimal health for all,’ the ADA must take an active role in the ongoing discussions to help craft the best strategies for senior dental care."

Other ADA councils share a different perspective.

The Council on Dental Practice also believes that any benefit dependent solution for dental eldercare should be a needs-based program rather than the age-based program proposed by the Oral Health America consortium.

“CDP recognizes that the ADA is committed to empowering the profession of dentistry to advance the overall oral health of the public and there is no doubt that the ADA should continue to advocate for efforts that meet the dental care needs of the elderly who cannot otherwise obtain care,” Dr. Ratner said. “Yet, we must be realistic and recognize that a needs-based program maximizes the ability of the program to provide care to those who need it and cannot afford it while preserving the Medicare program’s limited funding and other resources.”

In action in August, the Board of Trustees offered a comment to Resolution 33 that asks the House of Delegate to refer the resolution back to the appropriate ADA agencies so that a comprehensive strategy for addressing the needs of the growing elder care population can be addressed. In its comments, the Board noted that “as Americans live longer, growth in the number of older adults is unprecedented. In 2014, 14.5 percent (46.3 million) of the U.S. population was age 65 and older and is projected to reach 23.5 percent (98 million) by 2060. Currently, approximately one half of the U.S. population do not see a dentist for at least one visit a year.”

“The Council on Government Affairs understands that this is a significant issue for dentistry and for seniors," said Dr. Craig Armstrong, vice chair of the Council on Government Affairs. "This is something that the council has discussed extensively over the last year and as a result, believes taking the time to develop a comprehensive strategy for older adults would put the ADA in a strong position as we continue to advocate for our members and the patients we serve.” 

The reaction from ADA members on the issue seems to be mixed, based on feedback the ADA Practice Institute has received via email. Some believe it would be a mistake for dentistry to get involved in Medicare while others believe it’s dentists’ duty to ensure seniors have access to financing support for dental care.

2018 Report 1 of the Council on Dental Benefits Program is posted in the members only board Reports and Resolutions page of ADA.org on Page 3018 of the document (3000-3999) Committee B - Dental Benefits, Practice and Related Matters - All Inclusive.

Members who want to share opinions on this issue can email the council at dentalbenefits@ada.org. Comments will also be shared with other ADA councils and the Board of Trustees for review.