Medicare Dental Benefits
America’s older population may get expanded Medicare coverage for dental, vision and hearing.
Health insurance for America’s older population would be expanded under a $3.5 trillion budget plan released August 9th by Senate Democrats.
Dental and Vision benefits bit the dust in the final House bill passed on November 19th. Lawmakers once again listened to trade groups interested in protecting their profits instead of their constituents.
Hearing aid benefits made it into the final bill with restrictions keeping physicians and audiologist in control for the higher priced hearing aids. The Senate can still mess this up. Wait and see!
Additional benefits
As part of the budget blueprint, Medicare — relied on by most Americans once they reach the eligibility age of 65 — would cover dental, vision and hearing. Additionally, the age when people can sign up for the insurance would also be lowered, although it’s uncertain whether it would be age 60 as President Joe Biden has said he supports.
♦ There is a catch – all the Democrats in the Senate and almost all in the House will have to agree on the entire budget bill for the proposal to become law.
The House will reconvene on August 23rd to consider the budget resolution. Once the resolution has passed both chambers, the House and Senate majorities can proceed with the reconciliation process, a resolution is expected in the fall.
• The Senate budget blueprint includes few details about the proposed Medicare changes, other efforts to expand the program coverage could offer some clues.
A House bill introduced in July by Rep. Lloyd Doggett, D-Texas, would include things such as dentures, preventive and emergency dental care, refractive eye exams and eyeglasses, and hearing aids and exams.
The expanded coverage also was included in a broader health-care-related bill that cleared the House in 2019 but was not taken up by the Senate. Under that proposal, beneficiaries would have been responsible for 20% of some dental procedures.
Major treatments — i.e., bridges, crowns, root canals — would have cost more. Dentures also would have been covered. Routine eye and hearing exams, as well as hearing aids, contact lenses and eyeglasses, also would have been included.
♦ Hearing aids would be a big quality of life changer for many seniors. Currently 25% of those aged 65-74 and half of those older than 75 have disabling hearing loss.
Why is dental coverage important?
When people retire, they often lose their employer-provided dental insurance. This is at a time when their dental needs and costs are increasing.
• About two out of three adults 65 and older have gum disease.
• One in five adults 65 and older have untreated tooth decay.
• One in five adults aged 65 and older have lost all of their teeth.
According to the Kaiser Family Foundation, more than half of seniors had to delay dental care due to the high cost.
Dental disease is a serious problem for the elderly. It doesn’t only affect teeth.
Tooth loss and dentures can limit the types of foods that are comfortable to eat.
Gum disease can also increase the risk of stroke, heart attack and diabetes.
Doesn’t Medicare cover dental now?
Original Medicare does not cover regular dental care, vision or hearing. There is some coverage for accident-related procedures but routine care is not covered.
Many Medicare Advantage plans (Part C) provide some dental benefits. These are usually limited to a yearly dental allowance for preventive procedures such as exams, cleanings and x-rays. Tooth fillings or removal are usually not covered.
As of 2020, 88% of Medicare Advantage plans offered some type of dental coverage. About 40% of Medicare beneficiaries are enrolled in Advantage Plans.
♦ Insurers pushing profitable Medicare Advantage plans are apposed to adding this new benefit to traditional Medicare.
Many of these Advantage plans include a small dental reimbursement benefit as a draw to attract new members. The thought being that their plans would become less appealing when traditional Medicare provides dental coverage.
Dental insurance for seniors?
Stand-alone dental insurance plans are available but the plans are varied and confusing. Of course, the premiums are quite high.
Most plans offered to seniors, provide very limited coverage with lower yearly limits than what most seniors were accustomed to receiving before they retired.
Unhappy dentists
The American Dental Association (ADA) is pushing back on the idea of providing expanded dental benefits under Medicare. The ADA sees a general expansion of dental benefits under Medicare Part B as a threat to their income. This is logical since Medicare has some pretty tight price controls in place that sharply discount services.
The ADA has proposed that future dental benefits be provided by a separate new program, not under Medicare Part B. The ADA has also proposed that future dental benefits be limited to lower income Medicare beneficiaries.
The ADA proposed in a letter to Congress that expansion of Medicare benefits should be limited to beneficiaries whose income is up to 300% of the federal poverty level.
Estimates from the Kaiser Family Foundation show this would cover about 47% of the older adult population. What about the other 53%?
Apparently, those would be considered rich enough to pay out-of-pocket at standard rates.
