The Possibility of Medicare Dental Benefits Sparks Pushback

Dental benefits under Medicare are a possibility under the newly proposed infrastructure legislation, but there's lobbying against the issue in support of a separate program.

By Genni Burkhart

As Medicare currently stands, it doesn’t provide coverage for most vision, hearing, and dental care needs of beneficiaries. But that could change under the proposed social infrastructure legislation currently stalled in Congress.

Previously passed by the Senate, the U.S. House of Representatives advanced a budget resolution on Aug. 23 which includes a provision to expand Medicare to include dental benefits. There were, however, no specifics given on how this expansion would be structured, and at the time of this article, there’s no guarantee the entirety of this bill will pass into law.

This has lead the American Dental Association (ADA) to issue a response, stating on their website, “If the ADA does not lobby this issue, Congress will act without the ADA’s input, thereby creating a Medicare dental program that will not benefit patients or practitioners,” the FAQ said.

According to the ADA, any expansion of Medicare that includes dental benefits should be done through a brand new, separate program that's “dedicated to providing comprehensive dental care for low-income seniors.” They also explain the structure of the current Medicare Part B plan as “wrong for dentistry,” giving reasons as electronic recording requirements, coding and payment parameters, and unclear reimbursement issues, among others.

ADA and AMA Opposition to the Single-Payer System

From the outside, one might expect the dental profession to welcome dental coverage under Medicare. Not necessarily, as the Wall Street Journal reports.

While supporters argue that expanding Medicare to cover dental care would give benefits to some 60 million disabled and older Americans who’d perhaps not otherwise afford it, the ADA is asking their 162,000 members to oppose this proposal.

To be clear, the ADA is not against low-income dental benefits as that would subsidize care for those unable to obtain it themselves; they’re against “better-off” Americans, the core of their customer base, paying lower Medicare rates in comparison to what dentists currently charge. The ADA instead suggests that dental coverage be provided to only half of Medicare-eligible seniors. Specifically, those whose incomes are 300 percent or less of the federal poverty level, which amounts to approximately $38,000 per year.

Dentists are also concerned with how reimbursements would take place. As of 2020, the Bureau of Labor Statistics calculated the average salary of U.S. dentists as being $180,830. That’s a respectable salary, leaving critics to scoff at this opposition. But that number doesn’t take into account the variance in salary often impacted by location, and the amount of student debt dentists are often saddled with. Furthermore, dentists aren’t alone in the healthcare profession as opposed to government involvement.

In 1961 The American Medical Association (AMA) hired a well-known Hollywood actor (Ronald Reagan) to serve as their spokesperson in opposition to the enactment of the Medicare program, calling it the anti “socialized medicine” campaign. While the AMA still does not support a single-payer system, many of its members disagree and have protested the AMA to drop its fight against Medicare for All once and for all.

Public Health Problem

According to findings released in July of this year by the Kaiser Family Foundation (KFF), 24 million people, roughly 50 percent of all Medicare beneficiaries, do not have any dental benefits. The other half had coverage through private insurance, Medicare Advantage plans, or Medicaid.

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The KFF also reported that due to this insufficient dental coverage, many Medicare beneficiaries skip routine dental care and more extensive procedures, with that number disproportionately affecting black and brown people. This has created a public health problem where seniors are disproportionally deciding to forgo the dentist altogether. This has caused the American Association of Retired People (AARP) and the National Dental Association (NDA) to come out in support of Medicare expansion for dental benefits.

Challenging the Status Quo

Currently, Americans pay approximately $4 trillion a year for healthcare, which is more than any other country. In return, we get an antiquated system that does not provide coverage to millions of people, usually those most in need. Those who benefit from that current status quo are lobbying hard to ensure no significant legislation passes that would interrupt the system, as it stands.

At this time, the passage of this legislation is dependent on greater bipartisan support of the social infrastructure bill. That has yet to happen, as this legislation faces a tremendous amount of opposition and industry lobbying before it has any hope of passing through reconciliation, to finally add dental coverage, once and for all to Medicare.

Author: With over 11 years as a published journalist, editor, and writer Genni Burkhart’s career has spanned politics, healthcare, law, technology, business finance, and news. She resides on the western shores of the Puget Sound where she works as the Editor in Chief at DOCS Education out of Seattle, WA.

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