Dental Care For Seniors On Medicare - One in three Medicare-covered adults do not receive regular dental care, according to a survey by the Senior Citizens League (TSCL).
"We estimate that about 20 million older Americans miss annual cleanings, X-rays and dental checkups," said Mary Johnson, Social Security and Medicare policy analyst for TSCL.
Dental Care For Seniors On Medicare
Medicare does not cover routine dental health services, which often surprises first-time beneficiaries, TSCL reports. More than half of survey participants said they had no dental insurance coverage. Additionally, the high cost of treatment is often cited by those who do not receive the care they need.
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“I don't have the $7,000 they said I needed to fix my teeth. They either have to be removed with a bridge in place or a root canal,” said Elizabeth, a retiree living in Colorado. “When you have a limited income, I don't see anything being done in this area, and so it affects my health. in a negative way. Without dental care, I'm not as healthy as I could be.
Advanced age puts many retirees at risk for oral health problems, says TSCL. For example, dry mouth is a common cause of cavities and is a side effect of over 500 medications. Periodontal disease is also common, although it can be prevented with regular dental visits and cleanings. Additionally, research shows a strong link between oral health and other diseases.
Researchers have found links between gum disease and other inflammatory conditions such as heart disease, stroke, diabetes, respiratory disease and Alzheimer's disease. Improving oral care, however, can reduce medical costs in patients with inflammatory diseases, notes TSCL.
“To improve beneficiary health outcomes and reduce Medicare costs for diabetes and other inflammatory conditions, Medicare must cover routine dental care,” said Johnson, and more than 81% of survey participants were in agreement.
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TSCL supports federal legislation that could resolve the issue. HR 576, the Older Persons with Eyes, Ears and Teeth Act introduced by Rep. Lucille Royball-Allard of California, would expand Medicare to provide routine dental care. Additionally, S22, the Medicare Dental Benefits Act introduced by Senator Ben Cardin of Maryland, would also provide coverage for dental care.
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According to the National Institute of Dental and Craniofacial Research (NIDCR), about one in four people aged 65 and over (23%) have spent five years or more since their last visit to the dentist. In addition, 16% of people in this age group rate their oral health as “poor”.
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The American Dental Association (ADA) adds that people over the age of 60 often face some rather unique dental issues. For example, there are over 500 drugs that cause dry mouth, some of which are prescribed for high blood pressure, high cholesterol, Parkinson's disease and Alzheimer's disease. This is important because the ADA cites dry mouth as a "common cause of cavities in the elderly."
Other oral health problems that appear more frequently in older adults include gum disease and oral cancer, according to the ADA.
Unfortunately, having Medicare doesn't always help solve this problem. According to Medicare.gov, this federal health insurance program generally does not cover dental care, procedures, or supplies.
Medicare does not provide benefits for routine cleanings or services designed to treat and/or correct oral problems, such as dental fillings or extractions.
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Medicare will also contribute to the oral examinations required before a kidney transplant or heart valve replacement in certain situations.
Under Original Medicare Part A, participants may be covered for certain dental services received while in hospital. These include any "emergency or complicated dental procedures" deemed necessary at the time, according to Medicare.gov.
The Centers for Medicare and Medicaid Services (CMS) explains that while there are general dental exclusions for Part A coverage under Section 1862(a)(12) of the Social Security Act - a law that has not been amended since 1980, according to CMS - an example of emergency or complicated procedures that are often at least partially covered are the reconstruction of the jawbone that is necessary following an accidental injury.
Another example where Medicare Part A would cover a portion of a typical dental expense is if an extraction is needed to prepare a patient for radiation therapy following a jaw-related neoplastic disease. the growth of tumors, both cancerous and non-cancerous.
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According to CMS, Medicare will also help with the oral exam required before a kidney transplant or heart valve replacement in certain situations. Specifically, this type of expense may be covered by Medicare Part A if the exam is performed by hospital dental staff.
On the other hand, if the physician performs the necessary tests prior to a kidney transplant or heart valve replacement, CMS states that Part B benefits will apply.
However, when it comes to Medicare Part B, there are two specific sets of services that it will not cover.
The first relates to services used to care for, treat, remove or replace teeth in the structures that support them. For example, this may include the extraction of teeth before getting dentures.
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The second set of Medicare Part B services will not cover anything related to teeth and their supporting structures, unless the services are needed to treat a non-dental condition.
In this type of situation, the dental service must be performed at the same time as the covered service for Medicare to pay its share. It must also be performed by the same healthcare professional who performed the covered service, whether that person is a physician or a dentist.
An exception to the dental exclusion under Parts A and B of Original Medicare is Medicare Advantage. often called
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