Why Build Back Better Should Include a Medicare Dental Benefit

As the Build Back Better legislative package crawls through the legislative sausage-making in Washington, Senator Joe Manchin has said he opposes a new dental benefit in Medicare. As he explains it, he is worried about the financial future of Medicare.

This makes absolutely no sense at all and reflects an important misunderstanding about how Medicare works and is funded. But because it is the Senator’s stated reason for opposing something that older and disabled West Virginians need desperately, it merits examination.

But first a story. Then a few West Virginia facts. And then back to Medicare’s future.

I have a West Virginia friend who is in his early 70s and lives on a small, fixed income. During the summer, this gentleman started mentioning that he had a bad toothache and couldn’t chew. But he didn’t go to the dentist because he – like many of us - worried he couldn’t pay the bill and didn’t want to ask his kids for help or end up putting the bill on a high-interest credit card.

So he waited. And not surprisingly his cheek started to blow up and he ran a fever and felt pretty durn sick.

That forced him to the dentist. Maybe because he waited, the tooth had to pulled.

The dentist said that in order for my friend to chew properly, he needed a single tooth bridge. Nothing fancy. No tooth implant. And because my friend likes to eat, he agreed. The bill was $2600. And yes he did end up using a high-interest credit card to pay the dentist.

If my friend had needed a tooth next to the first one extracted as well, and a double bridge – not a uncommon scenario – he would have faced a bill of over $4,500.

And what if this senior citizen had been too worried about the bill and waited even longer to go to the dentist? He could have ended up in the hospital very sick from an infection that traveled from his mouth to his respiratory system, and or to his heart or brain. And the resulting cost to Medicare of a hospital stay and treatment would have been much, much higher. 

This gentleman’s story is not unique. 45 percent of West Virginians don’t see a dentist annually, even before the COVID pandemic. 26 percent of West Virginians lost all of their teeth; 56 percent lost 6 or more teeth. West Virginia is ranked at the bottom among the states and D.C. for overall oral health.

Now back to Senator Manchin’s concern about Medicare’s future – about Medicare solvency.

The technical 2021 Medicare Trustees report is the source of the concern about Medicare’s financial status. While full of caveats, the report projects a depletion of Medicare Part A trust funds by 2026 and suggests that this shortfall will need to be addressed with federal legislation. I agree. Limiting the profitability of Medicare Advantage plans is on my list of recommended fixes.

Here’s the misunderstanding. Part A pays only for hospitalizations. A Medicare dental benefit is NOT paid through Part A. Funding for a dental benefit would be paid through Part B, which pays for most outpatient care. Part B solvency is not at risk since it is funded through general revenues and premiums.

A dental benefit would strengthen Medicare’s Part A solvency by reducing hospitalizations and emergency room use triggered by untreated oral disease. A 2021 Avalere Health study that looked only at Medicare enrollees with diabetes and heart disease found a dental benefit could save Medicare at least $63 billion in 10 years.

Senator Manchin needs to understand that a Medicare dental benefit is one way to strengthen Medicare Part A solvency. 

If Senator Manchin does not want to make the upfront investment that will save Medicare money in the long run, then I’d suggest that he at least consider a compromise position. Perhaps a new Medicare dental benefit could have an initial annual or life-time cap per enrollee. I don’t like this idea, but it would limit the cost of a new dental benefit. If nothing else, perhaps the Build Back Better package could include a robust demonstration program that would (once again) show the long-term savings that a dental benefit could bring to Medicare.


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