All older people need their teeth. This means that they all deserve dental coverage through Medicare. | Opinion


By Cécile A. Feldman

Fortunately, we don’t live in a world where anyone wondering if Medicare should cover a broken finger because the little fingers aren’t considered an important part of the body. But when it comes to dental insurance, this is how the mouth has long been viewed.

Since 1965, when Medicare was created, oral health care has been deemed non-essential and excluded from coverage plans, perpetuating an arbitrary and nefarious division between medical and oral health. But we could take a step closer to change if Congress approves the Medicare Dental Benefit Act of 2021, which would provide dental coverage to all Medicare beneficiaries.

It is long overdue. Oral health is a crucial part of overall health, affecting the ability to eat, speak, and socialize. Infected teeth and gums not only cause excruciating pain, but can be fatal if the infection spreads to the bloodstream.

If you can’t chew properly, nutrition suffers. If you are too embarrassed to smile or speak because you have missing or disfigured teeth, it impacts your mental health and even your job prospects. Studies even show that people with severe tooth loss or cavities were less likely to be hired by employers.

For the elderly, dental care is particularly important. As we age, our teeth require more maintenance and often need to be replaced with dentures or implants. Under existing health insurance plans, oral health is only covered if it is considered “medically necessary”. This limits care to procedures such as dental checkups before cancer treatment or corrective measures to repair facial trauma. “But even this designation is arbitrary. Dental extractions before radiation therapy to the head and neck are covered, but infection prevention measures during transplant surgery and other cancer treatments are not. a patient suffers from a head trauma, the costs associated with hospitalization and surgery would be covered, but the restoration of teeth lost or fractured in an accident might not be.

Wealthier seniors may choose to purchase a Medicare Advantage plan, which covers routine care such as cleanings and fillings, as well as partial coverage for crowns and dentures. But many cannot afford it. According to the Kaiser Family Foundation, about 25 million Medicare beneficiaries have no dental coverage.

Americans know oral health is important. In polls, Democratic and Republican voters support expanding medicare to include dental coverage, but in Washington, Congress is divided among parties over whether to pass the bill.

If the Medicare Dental Benefit Act is approved, it would be a significant step for public health. But it would be much better if the government and the health insurance industry eliminated the medical / dental distinction.

Dental care should be as comprehensive as Medicare medical benefits, including routine checkups and catastrophic events. He would have to pay for preventative measures, such as cleaning his teeth, in addition to treating infections. There should also be coverage for cosmetic procedures that significantly improve mental health and the ability to earn a living, such as dentures or crowns for missing front teeth.

The American Dental Association (ADA) opposes extending Medicare dental benefits to all income levels, arguing that they should only be provided to low-income seniors. I strongly disagree. This is another way to separate dental health from medical health. No other aspect of Medicare has a financial eligibility test, so why should dental coverage be any different?

At the same time, ADA, which successfully lobbied against the inclusion of dental care when Medicare was created more than 50 years ago, has valid concerns. The administrative burden for dentists who accept Medicaid and Medicare is heavy because dental care is not integrated into the overall Medicare system. The reimbursement of health insurance involves significant administrative burdens. This burdens dentists with an additional layer of paperwork, which consumes staff time and energy. Streamlining the process and reimbursing dentists at rates that cover the costs of running a practice would help make their participation attractive.

It’s time for government leaders to recognize that a healthcare organization includes a healthy mouth and create a system of care that makes it easier for everyone to smile.

Cecile A. Feldman is Dean of the Rutgers School of Dental Medicine.

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