Prioritizing Our Seniors: Why Offering Medicare Dental Coverage Matters

More than 46 million seniors lack dental coverage, according to a 2015 report on enrollment from the National Association of Dental Plans (NADP) and Delta Dental Plans Association (DDPA). And that number is only expected to rise with our burgeoning population of older adults.

In order to help more seniors get covered, U.S. federal policy must more effectively address the oral health needs of this population.

Recently, there have been several big news stories about the barriers 70 percent of seniors face to receive quality oral health care.

One major contributor is that dental care is not covered under Medicare. Boston College researchers found that the percentage of people with dental coverage declines by more than half in the 10 years after reaching retirement age -- from 62 percent at age 65 to 26 percent at 75. Why? According to CBS News, the study suggests the following...

The reason: When most workers retire, they lose the dental coverage provided by their employer or union. But doesn’t Medicare, which starts at age 65, step in and pick up the slack? Not on your canines, “a fact that a majority of baby boomers are unaware of…”

According to a recent survey of 2,000 registered U.S. voters conducted by DentaQuest via Morning Consult, this is not a partisan issue. In fact, 83 percent of Republicans and 86 percent of Democrats responded that dental coverage should be included in Medicare.

Without coverage, seniors face significant out-of-pocket costs to obtain appropriate oral health care, as they are more likely to need the most costly procedures, such as crowns, implants, or false teeth as they age. Seniors are also more likely to have chronic conditions that may complicate or exacerbate these oral health issues.

Because traditional Medicare does not provide dental coverage, Medicare Advantage plans are taking a lead in providing oral health coverage for seniors. In fact, DentaQuest partners with many of these plans because they recognize the importance of oral health to the overall health of older adults. However, these benefits are optional or supplemental and not all seniors can afford to pay out of pocket for this coverage.   

More affordable solutions are necessary to bridge this gap for our seniors.

With all of the discussion surrounding changes to the Affordable Care Act and Medicaid, policies to expand dental coverage have largely gone overlooked. However, DentaQuest has taken steps to begin addressing this gap.

A few weeks ago, the DentaQuest Foundation announced a $668,000 grant to Oral Health America to expand the Wisdom Tooth Project and increase advocacy for publicly funded dental coverage for seniors. This project focuses on five strategies including education for seniors and professionals and pilot demonstration projects to combat barriers to care. The DentaQuest Foundation has been pivotal in supporting Oral Health America’s efforts for older adult oral health since 2010.

As health care prepares to undergo substantial changes, industry stakeholders may support different proposals but our goal should remain the same. We echo AHIP’s comments that the industry must bond together “to ensure every American has access to affordable coverage and quality care so they can achieve their best health.”

Expanding access to health care, including oral health care, is a foundational pillar to achieve this goal.

We cannot leave our seniors behind.

A [Dental] Wake Up Call for Baby Boomers

Guest Post by Dr. Michael Monopoli, DentaQuest Foundation Director of Policy and Programs

The baby boom generation has consistently enjoyed better health and better oral health than any previous generation. Thanks to community water fluoridation, fluoride toothpastes and having dental insurance as part of employer-sponsored health plans, this generation is the first where a majority will keep and maintain their natural teeth over their entire lifetime.

This is wonderful news, and the facts support it. CDC data shows that over the past decade, the number of adults missing all their natural teeth has declined from 31 percent to 25 percent for those aged 60 years and older. And more good news: Seventy percent of adults at or above the poverty level said they visited a dentist in the past 12 months (CDC Fact Sheet). This is a generation that cares about and values its good oral health.

But there’s a serious dental wake-up call on the horizon for this first wave of boomer retirees. Even with largely good oral health, today’s retiring adults are realizing they will have to plan to pay largely out of pocket for dental care to maintain their oral health beyond their working years.

Many have all of their teeth and received routine dental care through their lives. They are now struggling with the realization that Medicare generally doesn’t cover routine dental procedures, such as cleanings or fillings. Medicaid, the jointly-funded Federal-State health insurance program for low-income people, funds dental care for low income and disabled elderly in a few states, but reimbursements are low. Most dental plans that cover the necessary services to maintain good oral health are based on employment and these dental benefits are lost with retirement. Retirees now have to figure out how they can continue the level of dental care they enjoyed through their working lives, and will need to balance these expenses along with other important needs like food, housing, and the rest.

And to add insult to injury, over the past decade, the value of retirement funds and IRAs has been shrinking with the ups and downs of the economy. Some retirees are facing the fact that their retirement funds may no longer support the lifestyle they were used to or hoped for – including good preventive health services.

It’s not a comfortable feeling to have to decide what dental care you are willing to pay for in order to have good oral health -- especially when we know good oral health is an integral part of overall health.

This is one of the issues that was discussed by the new U.S. National Oral Health Alliance, leaders from dentistry, medicine, dental education and the dental industry, health advocates, policy makers and philanthropy at their first leadership colloquium in 2011. Without access to oral health care and prevention, our nation’s most vulnerable families are at high risk. Many middle class elders will begin to face dental issues that our nation’s most vulnerable families have faced for many years. Hopefully, this larger group will change the conversation.

Eradicating Early Childhood Caries

This year, the Centers for Medicare & Medicaid Services and other experts estimate that more than 300,000 children under the age of six, many from lower-income households, will suffer from Early Childhood Caries (ECC) and require hospitalization. These young children often have a mouthful of cavities and a potentially life-threatening bacterial infection that may cause them to seek hospitalization. Another 1.5 million children are considered at risk for ECC. Hospital resources are so limited that children requiring operating room care at one of the few hospital-based dental clinics commonly wait up to six months before receiving treatment. In the meantime, parents rely on powerful antibiotics to keep the infection in check. (Not much can be done about the pain).

Early Childhood Caries can be prevented. But to do this, young parents need the right information about the oral health of their babies and toddlers in time to prevent infection. Without access to preventive education and care, children may find themselves facing rampant cavities, a hospital stay, and residual lifelong disadvantages—such as malnutrition, school absences, and missed work.

We at the DentaQuest Institute are tackling this preventable, chronic childhood disease head on. Working in partnership with researchers at Children’s Hospital Boston, we have developed a clinical protocol for treating Early Childhood Caries that works with primary care providers and parents to improve treatment in the hospital and, most importantly, at home. This program is using education and case-management to help change behavior at home and the dental office. Where this treatment plan has been used, we have been able to reduce the percentage of young children (under 60 months) with new cavities by 69 percent; reduced those who needed treatment by 55 percent; and reduced reports of children with mouth pain by 50 percent. The DentaQuest Institute is now working to expand the ECC program to 10 dental clinics across 8 states—including MA, RI, OH, NY, FL, CA, WA and NY. In many ways, Early Childhood Caries is a parable for what plagues healthcare: small problems that turn into big problems because the right information and resources weren’t available in the first place to stop the progression. Preventive health care is part of the solution, but it means nothing unless you know how to use it.

Dr. Mark Doherty, Executive Director, DentaQuest Institute and Dr. Jay Anderson, Director of Quality Improvement, DentaQuest Institute

Using Performance Measurement to Improve Oral Health and Patient Care

This week, I have the pleasure of recognizing my colleague Dr. Rob Compton, who was recently appointed to the American Dental Association’s (ADA) Dental Quality Alliance (DQA) Advisory Committee on Research and Development of Performance Measures.

Dr. Compton, vice president of quality improvement for DentaQuest, is a nationally recognized expert on evidence-based oral health care and cost management methodologies. In 1999, Dr. Compton opened DentaQuest’s model dental office in Massachusetts. Its goal has been to deliver cost-effective, appropriate dental care using scientific, evidence-based technologies and treatments that are tailored to the dental needs of each patient. Today, under the direction of Dr. Peter Blanchard, the DentaQuest Oral Health Center is a thriving multi-specialty dental office—and the American Dental Association’s Adult Preventive Practice of the Year. Disease management and patient education are at the heart of its business and clinical systems. And for patients, that means healthier mouths, keeping their teeth for life, and much less need to drill and fill. The DentaQuest Oral Health Center has become a model for other dental offices who want to emphasize disease management in patient care.

Dr. Compton has brought the same thoughtful care and attention to quality improvement for better patient outcomes to DentaQuest’s dental benefit plan designs. He has encouraged DentaQuest to cover new services once they have been shown to have real impact on slowing the progression of dental and gum disease, particularly in higher-risk patients. His appointment to this ADA committee is acknowledgement of DentaQuest’s role as a major stakeholder and subject matter expert in high quality oral health benefits that emphasize cost and quality and which lead to improved patient outcomes.

The DQA was established by the American Dental Association in 2008 at the request of the Center for Medicare and Medicaid Services (CMS) which is also a co-sponsor. Its mission is to advance performance measurement as a means to improve oral health and patient care and safety through a consensus-building process.