As policymakers in Washington, DC, explore ways to make dental care more affordable for approximately 60 million Medicare recipients, the Kaiser Family Foundation on September 18 issued a brief that outlined five possible ways they may achieve this goal.
The brief aims to inform policy discussions focused on improving oral healthcare for two-thirds of the Medicare population who have no dental coverage and those recipients who have limited coverage.
Lawmakers and other stakeholders have begun looking for ways to improve access to care, recognizing the links between oral health and other life-altering diseases and that individuals forgo expensive care or incur high out-of-pocket costs for oral care services.
"Several approaches could make dental coverage more widely available and more affordable for Medicare beneficiaries," wrote the authors, led by Meredith Freed, a policy analyst at Kaiser's Program on Medicare Policy.
1. Add dental care to Medicare Part B
Under this approach, Part B enrollees would be entitled to Medicare-covered dental services.
It would be a relatively straightforward option for beneficiaries because dental services would be integrated seamlessly with other covered medical benefits. However, all beneficiaries would be required to pay for the new dental benefit through increased Part B premiums, regardless of whether they need or use dental services.
2. Create a voluntary dental benefit
This approach would allow beneficiaries to have the option of signing up for the new dental benefit in exchange for paying more. Since it would be a voluntary benefit, it would likely provide coverage to a smaller Medicare population than the first option, according to the brief authors.
3. Expand the definition of medically necessary dental care
Under this approach, the Medicare law would need to change to allow coverage for a wider range of conditions that require dental care, such as organ transplant procedures, cancer chemotherapy, and immunosuppression.
Also, this could make dental services available to recipients with specific chronic conditions, such as diabetes, that have been associated with improved health outcomes. However, those with oral health problems that don't meet the definition would not have their needs met.
4. Test models for coverage
The analysts suggested creating and testing models for providing dental coverage in specific circumstances or groups of patients. Examples might include subsequent emergency department visits after dental care or studying use by beneficiaries from specific geographic regions.
Since these models are often small in scale and cost, it would affect few beneficiaries unless the lessons learned from the models evolve into broader policy changes.
5. Offering dental discount cards
Another approach could be to provide Medicare beneficiaries with dental discount cards or other cash assistance to help cover dental costs. This approach would operate similarly to Medicare's prescription drug discount-card program, which was used before the Medicare Part D benefit was fully implemented.
This proposal has the potential to reach a large pool of beneficiaries and make services more affordable, as it would provide access to negotiated rates on dental services. The real effect it would have would depend on several factors, including the value of discounts and the extent of dental provider participation, the analysts noted.
Potential implications
Each proposal has potential implications for key stakeholders.
The first two options would directly impact federal spending but provide greater access to more recipients. They also would require decisions on numerous issues, including the scope of covered benefits, cost-sharing for specific services, provider rules for participation and payments, and assistance for low-income beneficiaries.
"The other three options would be expected to provide less help in improving dental coverage and reducing out-of-pocket costs for dental care and would have a more limited impact on Medicare spending," the authors wrote.
