The Dental Divide: Why Medicare Should Cover Dental Care

When it comes to U.S. health insurance, the mouth is a thing apart. Typically, dental care is separate from other health care, a division that is especially problematic for older Americans. Medicare, the federal insurer for 56 million people over 65, does not cover routine dental care, putting seniors who can’t afford private insurance at risk for problems ranging from tooth decay, gum disease and loss of teeth to pneumonia linked to gum disease bacteria and diabetes-related complications.

“We are keeping our teeth into old age, thanks to water fluoridation and better access to care during our working lives, but when we retire and lose those benefits, what do we do then?” asks health journalist Mary Otto, author of the book Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.

Recent Bloomberg School research found that only 12 percent of Medicare recipients report having some form of dental coverage and fewer than half saw a dentist in the previous year. “It was striking to really understand just how few people access dental services in the context of knowing how much they are needed,” says Amber Willink, an assistant scientist in Health Policy and Management and author of a 2016 study in Health Affairs that mined 2012 Medicare data to better define dental insurance deficits.

“So far, the conversations have been, ‘This is a big problem and we should do something about it,’” says Willink, PhD ’15, MPH. “We’re trying to put some numbers to this policy discussion.”

The researchers estimated the costs of Medicare-paid dental benefits under two separate proposals with differing premiums and subsidies to be between $4.4 billion and $16.2 billion annually. Willink says this type of hard data is needed to advance the policy debate.

“This issue is not going to go away,” she says. “People are ending up in hospitals and emergency rooms because they can’t afford to go to the dentist.”