Joe Martinez for Kaiser Health News
William Stork needs a tooth out. This is what the 71-year-old retired dentist told him during an examination.
This type of extraction requires an oral surgeon, which could cost him around $ 1,000 since, like most seniors, Stork doesn’t have dental insurance and Medicare doesn’t cover their dental bills. Between social security and his Teamsters pension, Stork says he can live comfortably in Cedar Hill, Missouri, about 30 miles southwest of St. Louis.
But the $ 1,000 cost is so high that he decided to wait for the tooth to come out.
Stork’s predicament is at the heart of a long-smoldering chasm within the dental profession that has re-ignited as a struggle to get dental insurance included in Medicare, the public insurance program for people 65 and older – if a benefit can be provided at all.
A unique opportunity for a generation
Healthcare advocates see President Biden’s Build Back Better agenda as a golden opportunity to ensure dental care for Medicare patients, almost half of it Didn’t visit a dentist in 2018 – long before the pandemic paused dentist appointments for many people. The rates were even higher for black (68%), Hispanic (61%), and low-income (73%) seniors.
The coverage has been exempted from a new framework announced by Biden on Thursday, but proponents still hope they can get the coverage in a final deal. Complicating their push is a debate about how many of the country’s more than 60 million Medicare beneficiaries should get it.
Advocates of dental insurance for everyone on Medicare face an unlikely opponent: the American Dental Association, which supports an alternative plan that only provides dental benefits to low-income Medicare recipients.
Medicare has excluded dental (and eye and hearing protection) since its inception in 1965. This exclusion was by design: the dentist profession did long fought to separate from the traditional medical system in order to maintain the autonomy of the field.
Dental care and health go hand in hand
More recently, however, dentists have emphasized the relationship between oral and general health. Most notorious is that 2007 death of a 12-year-old boy who could have been prevented by a $ 80 tooth extraction asked Changes to Maryland’s version of Medicaid, the state’s state insurance program for low-income people. But researchers also have dental care with them, for example reduced health care spending in patients with type 2 diabetes.
When the World Health Organization suggested postponing non-urgent oral health visits Last year to help prevent the spread of COVID-19, the American Dental Association Repelled, with Dr. Chad Gehani, then president of the organization, said, “Oral health is an essential part of general health. Dentistry is an essential part of health care.”
The Medicare proposal, backed by the ADA, would only cover seniors earning up to three times the poverty line. That currently equates to $ 38,640 per year for one person and would add up to the number of potential recipients of more than 60 million people R.about half this number.
Medicare has never required a means test, but in a world where Congress wants to cut the social spending package from $ 3.5 trillion over 10 years to $ 1.85 trillion over 10 years, the ADA has the gifts its alternative to save money while covering those who need dental care most urgently. A budget office of the Congress analysis estimated the plan to provide dental care to all Medicare beneficiaries would cost $ 238 billion over 10 years.
Research finds that cost is an obstacle to dental care
In contrast to the ADA, the National Dental Association is pushing for universal dental benefits from Medicare. The group, which “promotes equal oral health opportunities among people of color,” was founded in 1913, in part because the ADA did not remove discriminatory membership rules for its affiliates until 1965. Dr. Nathan Fletcher, chairman of the board of trustees of the NDA, says he wasn’t surprised to find his organization in dispute with the ADA over Medicare coverage.
“The face and the population of the ADA is a white man, 65 years old. Understand that those who make decisions for the ADA are usually those who have been in the practice for 25-30 years, are doing well, and are ready to retire, ”Fletcher says. “It doesn’t look like that [patients] we are talking about.”
Research from the ADA’s Health Policy Institute found Cost as an obstacle to dental care “regardless of age, income level or type of insurance”, but older, low-income adults were more likely to identify this as an obstacle.
Why Some Refuse Universal Medicare Dental Benefit
“It would be tragic if we didn’t do something for these low-income seniors,” said Michael Graham, ADA senior vice president of government and public affairs.
Graham is critical of the design of the proposals in Congress for a universal dental benefit from Medicare and notes that one includes a 20% co-payment for preventive services that could prevent low-income patients from accessing the treatment they would otherwise receive.
“Something is better than nothing, but the something [with a copay] is almost synonymous with nothing for many seniors, “says Graham.
The ADA covers 100% preventive services for low-income Medicare beneficiaries, he says.
Would Most Dentists Take Medicare Patients?
Of course, if you only cover low-income seniors, the biggest question is: will dentists even accept Medicare if they don’t have to? Often times, low-income patients seek dental care in safety net clinics that plan months in advance. Some dentists fear that Medicare benefit limited to older, low-income adults would be easier to avoid, pushing even more newly insured Americans into an already strained dental safety net.
Less than half in total of US dentists accept Medicaid, although more than 60% of NDA members do, according to Fletcher. The ADA Care for the reimbursement rates and paperwork for a Medicare benefit will be similarly unattractive to many of its members.
But Fletcher, dentist director for a Medicaid insurance company in Washington, DC, says participating in Medicaid varies greatly States – and as with Medicaid, participation in any new Medicare dental program would depend largely on the design of the benefit.
If the reimbursement rates for Medicare coverage are high enough, Fletcher said, it could be very lucrative for dentists to cover tens of millions of seniors. Ultimately, he says, dentists should have a choice of whether to enroll Medicare patients, and all Medicare patients should be eligible for dental benefits because they have paid into the program.
A generation break in the job
Dr. Nathan Suter, William Stork’s dentist, feels it is right to add a dental benefit for all seniors.
As a self-proclaimed “proud ADA member”, Suter is at odds with the organization that showered him with awards. He was named Dentist of the year from the affiliated Missouri Dental Association in 2019 and received one of the ADA awards for young dentists in 2020.
“As an ADA member, I think they should sit at the table for me and make sure that all of my seniors are as good as possible,” says Suter, who estimates that at least 50% of the patients in House Springs in his practice , Mon, are older adults.
But instead of pushing for a universal benefit, the ADAs are well-funded lobbying is push against The plan proposed by Congressional Democrats to add dental care to all Medicare beneficiaries. The organization has asked its members to email congressional representatives on the matter; More than 60,000 emails have been sent so far, says Graham.
Suter sees the fight over whom to cover as a generation break. As an aspiring dentist, he prefers to add full dental coverage now so that he can adapt his business model sooner. And the more seniors receive dental services, the larger their potential customer base becomes. Dentists like him, who are still setting up their practices, have less time to meddle in ADA’s policy-making process, he says.
Embroiled in this are patients like Stork, who says the availability of Medicare dental coverage is one reason he withholds the necessary tooth extraction, even though he knows that benefit is unlikely for years if it is done at all.
Stork also knows that benefit may not cover a middle class person like him, even if approved. Still, a cover would be nice if his tooth couldn’t wait any longer to come out.
Kaiser health news is a national, editorially independent program of the Kaiser Family Foundation and is not affiliated with Kaiser Permanente.
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