Nearly 20 percent of Americanson Medicare report that they spent more than $1,000 out-of-pocketon dental services.(Photo: Shutterstock)

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A new study by the Henry J. Kaiser FamilyFoundation (KFF) outlines some serious issues raised by the lack ofroutine dental care coverage under the federal Medicaresystem.

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At a time when Medicare for All has become a national issue,with many politicians promoting it as a way to provide auniversal system of health care in America, the KFF study is areminder that even relatively robust coverage systems can haveserious gaps.

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Medicare—no routine dental coverage

Medicare covers approximately 60 millions Americans, both oldercitizens and many younger Americans who have disabilities. Thesystem will cover emergency dental care in some cases, as well asextractions due to cancer treatment or other medically coveredissues. And Medicare Advantage plans can offer dental coverageoptions.

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But basic Medicare plans do not cover routine dental healthcare, such as preventive care and checkups, and the KFF study looksat what that lack of coverage means for Medicare recipients.

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“Limited or no dental insurance coverage can result inrelatively high out-of-pocket costs for some and foregone oralhealth care for others,” the study said.

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Currently, about 65 percent of Medicare beneficiaries do nothave dental coverage—equaling 37 million people without coverage.Overall, nearly half of Medicare beneficiaries have not visited adentist in the past year. Among rural residents, nearly 60 percentof Medicare beneficiaries did not see a dentist in that time.

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And as with other areas of health care, there are strong racialdisparities in dental care: 71 percent of African Americans, and 65percent of Hispanic beneficiaries did not see a dentist in the pastyear—compared to 43 percent of white Medicare beneficiaries.

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Health and pocketbook both suffer

For those who do get dental care, the costs are high. Nearly 20percent of Americans on Medicare report that they spent more than$1,000 out-of-pocket on dental services. As the report notes, withhalf of Medicare beneficiaries living on less than 26,200 per year,such high costs can be a large percentage of their incomes.

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As a result, many beneficiaries, especially low-incomeAmericans, go without care. And that lack of care takes its owntoll. Fifteen percent of Medicare beneficiaries no longer havenatural teeth—and this is more common among those with lowerincomes. The study notes that being edentulous (having no naturalteeth) can have quality of life impacts, and can affect nutrition,as those without teeth may avoid some fruits and vegetables.

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Many other negative outcomes associated with lack of oral healthmaintenance. “Oral health examinations can identify nutritionaldeficiencies, HIV, certain microbial infections, and some cancers,”the study noted. “In addition to reflecting underlying disease,poor oral health can exacerbate general health issues and systemicdiseases. Periodontal disease, or advanced gum disease, isassociated with increased risk of cardiovascular diseases,including arteriosclerosis, coronary heart disease, and stroke,increased risk of mortality for those with chronic kidney disease,adverse pregnancy outcomes, increased risk of cancer, and poorglycemic control for diabetes.”

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The study added that dry mouth is common side effect ofmedications taken by many elderly Americans, and that condition cancause a host of other dental health issues, if not monitored andtreated as part of regular care.

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No quick fixes

Solutions will have financial costs, the study said, but itadded that Congress has not yet estimated the cost of adding adental benefit to Medicare. “Given the significant health risksassociated with poor oral care and the costs and consequences ofuntreated dental needs, identifying potential solutions to improvethe oral health status of the Medicare population remains achallenge,” the report said.

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