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

A new study by the Henry J. Kaiser Family Foundation (KFF) outlines some serious issues raised by the lack of routine dental care coverage under the federal Medicare system.

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

Medicare—no routine dental coverage

Medicare covers approximately 60 millions Americans, both older citizens and many younger Americans who have disabilities. The system will cover emergency dental care in some cases, as well as extractions due to cancer treatment or other medically covered issues. And Medicare Advantage plans can offer dental coverage options.

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

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

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

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

Health and pocketbook both suffer

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

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

Many other negative outcomes associated with lack of oral health maintenance. “Oral health examinations can identify nutritional deficiencies, 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 systemic diseases. Periodontal disease, or advanced gum disease, is associated 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 poor glycemic control for diabetes.”

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

No quick fixes

Solutions will have financial costs, the study said, but it added that Congress has not yet estimated the cost of adding a dental benefit to Medicare. “Given the significant health risks associated with poor oral care and the costs and consequences of untreated dental needs, identifying potential solutions to improve the oral health status of the Medicare population remains a challenge,” the report said.

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