Caring for older Americans’ teeth and gums is essential, but Medicare generally doesn’t cover that cost

Many cancer treatments can damage teeth, especially for older adults.

As a result, Medicare has started to reimburse for dental bills tied to tooth decay or other oral conditions after they get chemotherapy or radiation treatment.

The history of U.S. health care helps explain why Medicare generally won’t cover the cost of dental and gum treatment.

Doctors and dentists are educated separately, and doctors learn very little about dental conditions and treatments when they’re in medical school.

Most dental electronic health records aren’t linked to medical systems, hindering comprehensive care and delivery of dental care to those in need.

At the same time, medical insurance and dental insurance have evolved to serve very different functions. Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was intended to mainly fund predictable and lower-cost preventive care.

While protection from catastrophic medical costs has always been perceived as a necessity, coverage of dental services was conceived as a benefit that’s mostly nice to have.

But that’s an outdated idea disconnected from a large body of scientific evidence.

Until Medicare expands coverage to include preventive dental services for everyone, alternative plans such as Medicare Advantage, through which the federal government contracts with private insurers to provide Medicare benefits, serve as a stopgap.

In 2016, only 21% of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas roughly two-thirds of Medicare Advantage enrollees had at least some dental benefits through their coverage. However, these plans vary greatly in the procedures that they cover.

The costs of this hole in Medicare coverage is high: 1 in 5 Americans with Medicare – including many with little disposable income – are spending at least $1,000 a year on dental care.

It seems that Dr. Koop was onto something – you can’t be healthy without good oral health. Adding basic dental benefits to Medicare would likely help many older Americans to live happier and healthier lives, and at the same time potentially reduce overall health care costs.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and analysis to help you make sense of our complex world.

Frank Scannapieco is affiliated with The Task Force on Design and Analysis in Oral Health Research, and consults for the Colgate-Palmolive Company.

Ira Lamster is a member of the Santa Fe Group. He currently receives consulting fees from Colgate, and research support from the CareQuest Institute.