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My Turn: A whole person, not a set of symptoms

For the Monitor
Published: 10/18/2021 7:00:17 AM

A few years back I met a couple who had recently returned from Mexico for extensive dental work. Turns out it is much more affordable in many countries where Americans go to avoid prohibitive costs (and that is factoring travel expenses!) In fact, there are travel companies that specialize in “dental tourism,” and some countries spend part of their travel and hospitality budget promoting safe and affordable medical treatment.

The savings for common dental procedures is significant. 2019 data shows that in the top ten dental travel destinations, patients can expect to save between 40% - 75% of typical dental costs in the U.S. I figured my traveling friends had dental coverage for basic and prevention visits, and like my dental plan where I was employed, minimal coverage for more expensive or invasive procedures.

So when I became eligible for Medicare, I, like many newcomers to the system, was surprised to learn that dental coverage is not included in Part B. Medicare doesn’t include dental treatment necessitated by medical treatments or illnesses, including chemo and radiation therapy and medications causing dry mouth (because decreased salivation leads to increased potential for cavities). People needing organ transplants, heart surgery and leukemia treatment often require dental clearance first. These clearance visits also are not covered by Medicare.

Pre-pandemic (2018) data published in July by the Kaiser Family Foundation shows that 47% of Medicare-eligible seniors did not see a dentist in the previous year. Not surprisingly, the rate is higher for low-income seniors (73%), those reporting fair to poor health (63%), and those who are Hispanic (61%) or Black (68%). Poor oral health is associated with a variety of health conditions, including heart disease, pneumonia, diabetes, osteoporosis and Alzheimer’s disease.

While traditional Medicare plans do not include dental coverage, Medicare Advantage plans can offer dental treatments as well as some other benefits such as vision and hearing. But there are drawbacks, including limited coverage and small groups of providers where the plans are more of a health management organization (HMO) than a traditional fee for service. HMOs often require pre-authorization and limited choice of providers approved by the insurer.

A 2021 review of Medicare Advantage dental plans by the Kaiser Family Foundation found that most cover 50% of non-preventative treatments (after the deductible has been met). 78% of people enrolled in Medicare Advantage have dental plans that cap benefits. 59% have plans that allow a maximum benefit of $1,000. A vast majority of plans limit the number of dental visits per year.

The American Dental Association is lobbying against expanding Medicare B plans to include dental health. They give several reasons, starting with the lack of billing, recordkeeping and claims structures in dentistry practices that are currently required by Medicare, as well as concerns about being reimbursed at rates lower than dentists currently charge. Instead, they propose a plan to provide a “range of services necessary to achieve and maintain oral health” to seniors whose income is at or below 300% of the federal poverty level.

Navigating the medical and insurance systems is complicated enough. For example, in addition to the variety of Medicare Advantage plans available, there are several supplemental (Medigap) plans that seniors can purchase to offset costs related to co-payments and deductibles to choose from.

The original intent of Medicare was to provide insurance to all seniors 65 years of age and older. There are now different rates people pay for their premiums based on annual income, but all people get the same basic services. And while dentistry may not use electronic records, procedure codes and claims submissions in the same form as physicians, this does not seem to be a reasonable objection to including dental care as a basic benefit. Medicare B includes not only physician services, but outpatient services such as physical and occupational therapy, durable medical goods (oxygen tanks, wheelchairs, hospital beds), emergency ambulance care and laboratory tests. Surely each of these services required changes in billing, reporting and reimbursement protocols to be compliant with Medicare guidelines.

Just as the hip bone’s connected to the thigh bone, the circulatory, digestive and respiratory systems all involve the mouth and carry good germs and worrisome bacteria throughout the organs they visit. The mouth is an integral part of the body, not a separate system. Patients do best when treated as a whole person and not as a set of symptoms. And so a comprehensive health insurance program that promotes prevention and treatment to all systems of the body ensures a better quality of life throughout the aging process.

We don’t need a separate dental program for some seniors. Let your representatives in Congress know that dental care is vital to overall health and should be covered by Medicare for all seniors.

(Lynn Merlone lives in Rindge.)

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