Millions of Americans lack access to proper dental care, especially seniors. Without private insurance packages that include dental coverage, over half of seniors 65 and older are skipping the dentist.[1] According to a MemberBenefits article, a common checkup at the dentist can cost a patient $290, making a visit to the dentist a luxury that many seniors without insurance coverage can’t afford.

On August 11, the Senate passed a $3.5 trillion Medicare expansion package that includes coverage for vision, hearing, and dental benefits. As it stands now in the legislation, the U.S Senate’s approved budget resolution for dental benefits would cover all Medicare beneficiaries, be included in Medicare Part B, and cost approximately $238 billion over ten years.

Since voting to approve the $3.5 trillion budget resolution on August 25, House Democrats are moving forward with the legislation. The 220-212 party-line vote allows Democrats to write and approve the package without Republican support. The bill now moves to reconciliation, fast-tracking it through Congress. Democrats believe the $1 trillion bipartisan infrastructure bill that has advanced is a key part of passing the budget resolution. House Speaker Nancy Pelosi has said that she is “committed to passing the bipartisan infrastructure bill by September 27”. Pelosi has stated that both the infrastructure and reconciliation bills are tied together and will “only vote for the infrastructure bill after passing the reconciliation bill.”

However, the American Dental Association (ADA) has concerns.

In an August 12 letter, ADA President Daniel J. Klemmedson, D.D.S., M.D. advocated for an expansion of Medicare benefits for those whose income is up to 300 percent of the federal poverty level.

ADA President Daniel J. Klemmedson, D.D.S., M.D.

“This would provide meaningful coverage to most seniors who presently do not visit a dentist because they cannot afford it. Rather than extend the benefits to those who can pay dental fees, the ADA suggests focusing on patients who lack the financials to pay out of pocket.”

ADA President Daniel J. Klemmedson, D.D.S., M.D.

Taking Dr. Klemmedson’s statement one step further, former ADA President, Joseph P. Crowley, D.D.S., proposes including these benefits for those who have access to Medicaid as well.

“The story has to start way before the age of Medicare,” Dr. Crowley said. “For people who are at risk between ages 18 and 65, it’s very difficult for them to have access to dental care. When they aren’t getting the care and then all of a sudden, they have a robust dental benefit, there is going to be a backup of oral health issues.”

For dentists, what’s the missing piece in the U.S Senate-approved Medicare expansion budget resolution?

The one thing missing from the proposed legislation? A clear reimbursement rate for dentists. Currently, Medicare reimburses healthcare providers an average of 80 percent of the total bill. However, within the Medicare expansion package, there is no mention of what those reimbursement rates would look like for dentists. With high overhead costs and expensive procedures, tending to patients who use Medicare can prove to be costly for the dentist.

While Americans eagerly await more information on decisions from lawmakers, Dr. Crowley argues that any conversation on the topic of Medicare expansion is worthwhile and necessary.

Former ADA President, Joseph P. Crowley, D.D.S.(Courtesy ADA News)

“I am excited that the conversation surrounding oral health is being had. No one is discounting the fact that people should have access to care, the difficult discussions will be surrounding the economics of the package.”

FORMER ADA President, Joseph P. Crowley, D.D.S.

A YouGov survey found that 82% of voters in the 2022 Senate battleground states favor Medicare expansion, according to [2] Oral health is the window to overall health. Inclusion of dental benefits in Medicare will bring crucial care to those currently unable to access a dental practice no matter their circumstances.