Medicare Dental Benefit Pushed to 2028 Under Democrats’ Bill (1)

Seniors on Medicare would get vision and hearing benefits over the next two years but would wait until 2028 for dental coverage under legislation a key House panel announced Tuesday.

The measure, set to be a central part of Democrats’ $3.5 trillion domestic policy package, would be one of the largest expansions of Medicare benefits since its prescription drug program was created almost 20 years ago.

“This is our historic opportunity to support working families and ensure our economy is stronger, more inclusive, and more resilient for generations to come,” Rep. Richard Neal (D-Mass.), chair of the House Ways and Means Committee, said in a statement.

House Democrats Push Ahead on Medicare Expansion, Family Leave

Photo: John Moore/Getty Images

A patient receives an eye exam at a free health clinic on July 22, 2017, in Wise, Va.

The proposal would first create a vision benefit in 2022, followed by hearing coverage in 2023, and then dental benefits starting in 2028. It holds the potential to increase the quality of life significantly for seniors, many of whom lack supplemental coverage for the services.

Dental coverage is by far the most expensive of the three programs for Medicare: the nonpartisan Congressional Budget Office previously estimated that such coverage would cost $238 billion over 10 years, compared with $30 billion for vision and $89 billion for hearing coverage.

The Ways and Means Committee is set to start considering the legislation Thursday. Democrats plan to advance the package using reconciliation, a procedure that bypasses the need for Republican votes in the Senate. Medicare benefit expansion has the backing of several key Democrats in that chamber, including Majority Leader Chuck Schumer (D-N.Y.), Budget Chairman Bernie Sanders (I-Vt.), and Senate Finance Chairman Ron Wyden (D-Ore.).

The Ways and Means markup will also include legislation to fund physician training, bolster elder justice programs, and address staffing shortages in long-term care facilities. Its hearing coverage wouldn’t include over-the-counter devices.

Implementation Challenges

The legislation would leave important details up to the Department of Health and Human Services, including the payment rates for dental services.

Dentists would remain excluded from the Merit-Based Incentive Payment System, Medicare’s quality improvement program that determines payment adjustments.

Tricia Neuman, who studies Medicare at the Kaiser Family Foundation, said the government may need years to set up the new dental benefit because few dentists are currently enrolled in Medicare. It could take Medicare years to educate dental practices about the program, she said.

Under the proposal Medicare would pay only half the costs for major dental treatments, such as bridges, crowns, and root canals. Michael Monopoli, vice president for grant strategy for CareQuest Institute for Oral Health, a nonprofit that pushed for the dental benefit, said that coverage should be closer to the 80% payment for most similar Medicare services.

“This will be a major benefit in Medicare members’ lives,” he said, adding that he thinks the benefit should start before 2028.

Dental Popularity

Just over half of adults 65 or older currently have dental coverage, a University of Michigan survey found. About half of those with coverage are covered as employees or retirees, or spouses of employees.

Giving dental benefits to senior citizens polls well among Democrats, according to a 2019 survey by Families USA. Roughly 7 out of 10 likely voters said they support adding oral health coverage to Medicare and 8 in 10 Iowa Democrats favor adding a dental benefit to Medicare, the survey reported.

About 26% of Medicare beneficiaries, roughly 13 million seniors, had access to some dental coverage through Medicare Advantage —Medicare plans offered by private insurers—as of 2019, according to the Kaiser Family Foundation. An additional 7.2 million Medicare enrollees are also eligible for Medicaid, which has dental and other benefits that Medicare doesn’t cover, HHS figures show.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Sarah Babbage at sbabbage@bgov.com; Robin Meszoly at rmeszoly@bgov.com