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Community Statement Highlights Need for Medicare Coverage for Medically Necessary Oral Care

Photo by Daniel Frank on Unsplash

Many people with Medicare lack coverage for oral and dental services, despite the clear need for such care. Untreated infections in the mouth have been closely linked to other chronic conditions like rheumatoid arthritis, dementia, stroke, and heart disease. In addition, people without dental care may have pain or looseness in their teeth or may lose teeth altogether. In 2019, 17% of people 65 or older had no remaining teeth.

Access to oral health care is also an equity issue. There are clear racial and ethnic disparities in access to such care, and people with low incomes are especially affected. The lack of comprehensive coverage through Medicare, and the spotty coverage through Medicaid, leaves many older adults and people with disabilities forced to pay out of pocket for dental care, including most forms of medically necessary care.

While Medicare Rights continues to advocate for legislation to expand Medicare to include comprehensive dental benefits, we are also working with partners ongoingly to secure coverage of “medically necessary dental” care administratively—an interim step that would complement but not require a legislative fix.

Medically necessary dental care is care that treats oral disease that would otherwise likely delay or jeopardize the effectiveness of important and life-saving medical treatments such as organ and stem cell transplantation, heart valve repair or replacement, chemotherapy, and management of autoimmune diseases. While Medicare is not currently permitted to cover most dental care, medically necessary care is, as the term suggests, medically necessary for the effective use of Medicare covered treatments. Therefore, it may be possible for the Centers for Medicare & Medicaid Services to interpret such care as falling outside of the routine dental exclusion.

Medicare Rights joined with over 230 other organizations, including medical and dental associations, health care groups, and advocates to explain the need for medically necessary dental coverage in Medicare. The statement draws upon the experiences of experts and advocates who have seen the problems people with Medicare encounter while this coverage gap remains. The goal of this statement is to bring attention to this important need and spur change.

Medicare Rights will continue to advocate at both the Congressional and the Administrative level to expand coverage for oral health care to reflect the reality that dental health is intrinsically linked to whole-body health.

Read the Community Statement on Medicare Coverage for Medically Necessary Oral and Dental Health Therapies.

Read more about legislative options to provide comprehensive dental coverage in Medicare.

Policy Issues: Coverage and Benefits
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