Although many seniors are able to gain additional healthcare coverage once they qualify for Medicare, it’s not all good news — especially for their teeth.
Despite the fact that the U.S. dental industry has grown by 2.5% during the last five years, the majority of Medicare recipients do not gain dental care coverage through their insurance policies. In fact, 65% of all Medicare beneficiaries (equal to 37 million people throughout the nation) have no dental coverage at all. Since Medicare does not pay for cleanings, fillings, dentures, or crowns — the preventative and restorative treatments seniors are likely to need most — many older Americans are forced to pay for these services out of pocket. Medicare members who visited a dentist during 2016 paid $922 on average for these services, which can present a significant financial burden to those who are retired and are living on fixed incomes. As a result, Kaiser Family Foundation data revealed, 49% of seniors had not been to the dentist in the last year. It’s important to note that 63% of Americans plan to work after retirement age.
That last piece is alarming, considering that oral health has a direct impact on overall health and well-being. According to the data, six in 10 of those surveyed who reported themselves to be in fair or poor health did not go to the dentist during the past year. Whether the lack of care attributed to the poor health or the participants’ poor health kept them from going to their dentist is unknown. But forgoing preventative care can result in expensive emergencies later on, as is evidenced by the thousands of dollars many seniors are forced to pay when they experience dental decay. Even if you do obtain private dental insurance coverage on top of your Medicare health plan, that might not keep you from paying large sums. Although programs like Medicare Advantage can cover some of the cost, seniors with these additional policies may still have to pay several hundred or even thousands of dollars to obtain the dental and oral care they need. And since bankruptcies resulting from unpaid medical bills affected an estimated 2 million people in the U.S. during 2013, it’s no wonder that many seniors would rather put off dental treatments than face higher monthly premiums and substantial payments for treatment on top of them.
But forgoing dental treatment can risk more than money. Poor oral health is associated with the need for costly (and potentially preventable) emergency department visits, as more than 2 million ED visits take place each year among Americans due to oral health complications. Still, many seniors are willing to take the risk simply due to overwhelming costs. Roughly 10% of Medicare beneficiaries did not receive the dental care they needed during the past year because they couldn’t afford it. Of course, dental anxieties and inconveniences may play a part in seniors failing to make and keep appointments with their oral care specialists — but lack of affordability tends to play the most important role.
Although dentists originally were resistant to the idea of being included in Medicare coverage and thereby being subjected to a fee schedule, there are other factors that are keeping Medicare from adding dental care coverage now. The costs of adding the coverage and the implications for federal spending and beneficiary premiums are keeping the situation as it currently is. While lack of dental coverage under Medicare is certainly nothing new, what we now know about oral care’s role in overall health means that there’s much more urgency to find a solution. The federal government is considering a few different options, like separate benefits or new benefits created exclusively for low-income beneficiaries. But as yet, no perfect solution has emerged — and it’s likely that many seniors will continue to weigh their need for dental services against their exorbitant costs for the foreseeable future.