Increase Adult Dental Benefits to Improve Outcomes, Lower Costs

Medicaid and Medicare dental benefits are often limited, which means adults with lower incomes and older adults get dental care less frequently than they should. There’s a ripple effect from untreated oral disease. Pain and dysfunction can lead to tooth loss, complex chronic diseases, hospital visits, and employment issues.  

As outlined in Reversible Decay: Oral Health is a Public Health Problem We Can Solve, a focus on improving medical-dental integration, expanding public benefits and other solutions can help address these access issues.
 

Americans overwhelmingly support expanding oral health access through Medicaid and Medicare. 

Most Americans are unsure or incorrectly believe Medicaid (74%) and Medicare (62%) already cover dental treatment. Regardless of their understanding, 78% of respondents support Medicaid dental coverage and 80% support Medicare dental coverage.   

 

Should These Programs
Include Dental Benefits?

(among all patients)​

78 and 80 percent pie charts

     
  Advocating for Adult Dental Benefits in Your State
 
 
  Adult Benefit Video Still  
 
 
 
  Medicaid Adult Benefits by State:  
     
  2019 was a banner year for state action on Medicaid adult dental benefits. Find out about the states that expanded access or enhanced benefits, and those that are still facing challenges.
Learn more »

 
 
     
  Health Affairs: Addressing Rural Seniors' Unmet Needs for Oral Health Care  
     
  This blog post written as a DentaQuest and Families USA collaboration outlines just how Medicare oral health coverage could improve access and affordability.
Learn More »
 
 
     


What’s more, experts indicate comprehensive dental coverage will help prevent diseases related to untreated oral health issues, improve overall population health, and bend the cost curve related to avoidable emergency dental care and chronic disease management.
 

Most Important Benefits of
Comprehensive Dental Coverage Under Medicaid

(among Medicaid Dental Administrators)

68%  Prevents development of diseases related to untreated oral health issues
59%  Improves the health of the state population
59%  Leads to savings on emergency care
56%  Leads to savings on chronic disease management
34%  Improved oral health allows individuals to find and maintain jobs
17%  Cost-effective for the state's budget

 

Despite the overwhelming agreement those reliant on Medicaid and Medicare should have dental coverage, there is no mandate to include the treatment of dental disease.  

Coverage for adults under Medicaid varies from state to state, and those adult Medicaid dental benefits are often the first targeted for state budget cuts, especially in difficult economic times. As it stands, 68% of Medicaid state dental directors do not think their state programs adequately budget for oral health care. When asked whether they believe the current funding in their state is adequate, 68% of Medicaid dental administrators disagreed.
 

"Medicaid Dental Funding in My State is Adequate."
(among Medicaid Administrators)

 
pie chart     7% Strongly agree
    12% Somewhat agree
    15% Neither agree nor disagree
    22% Somewhat disagree
    44% Strongly disagree 


 

Medicare, meanwhile, is a federal program without mandated coverage for the treatment of dental disease. But recent developments such as The Lower Drug Costs Now Act indicate a shift in the national discourse about oral health. If passed into law, about half of the $456 billion in savings achieved by lowering drug costs over the next decade would instead fund expanding Medicare benefits to include dental coverage, according to the Congressional Budget Office.  

The lack of dental insurance coverage means adults continue to struggle to stay healthy, while states and the federal government continue to rack up avoidable costs. Providing, or expanding, adult dental coverage can lead the way to reducing costs for patients, dentists and states, as well as lowering the incidence of diabetes and other diseases and improving overall health outcomes.