Time for Some Teeth in Health Policy?

Maybe it’s all those gap-toothed pumpkins staring at me, but I started thinking about teeth, mouth, oral health, dentistry, and the strange landscape of American public health. I don’t know about you, but my last mirror session confirmed that my teeth were in my mouth, which is in my body. And my brain is in my skull, which connects to the vertebrae, which connects to…you get the idea.

The world of health policy has seen bitter battles for “mental health parity,” which at its core is the notion that emotional well-being and physical well-being are interconnected and should be treated holistically. (Health politicians love the word holistic, so I started using it holistically.) So it slowly dawned on me that there was no point in separating oral health from “health” and not looking at dental procedures from a health care perspective.

Doing a little research, I learned that the dental profession in the United States was initially supported by the medical profession, but split there—particularly when the American Dental Association achieved its political goal of being expelled from Medicare when it was founded in 1965 . That explained the strange state of the country, but which is the right thing?

First, there is no doubt that there is a link between oral health and overall well-being. This is intuitively correct and has been proven by countless studies. But there are a number of dental health procedures – most of mine are low-maintenance cleanings – that are more or less related to general health. So, Second, it’s easy to overestimate the extent to which better dental health actually improves overall health. The real question is how To integrate oral health considerations into an overall health benefit.

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The private sector should have leeway in designing its plans to answer this question as it sees fit. For government programs – Medicare, Medicaid, Affordable Care Act, etc. – simply adding uncoordinated dental reimbursement is a great way to subsidize elective dental care that has no health implications, underfunds basic dental care, and generally makes no progress. (Currently there is limited dental coverage in the children’s health insurance program, just over half of the Medicaid programs, and select circumstances in Medicare.)

But wait, there is an existing system that provides dental benefits, takes care of the interactions between oral and other health, and has the ability to differentiate between elective and essential oral health interventions: Medicare Advantage (MA). Every senior has access to MA plans that offer dental benefits (so it’s definitely not true that Medicare doesn’t cover dental benefits).

MA offers an opportunity to develop practical evidence of an effective means of incorporating oral health considerations into a care plan. It’s another reason to celebrate the fact that increasing numbers of seniors (more than half in the near future) are opting for a Masters.

Chart Review: Dental Care Among Medicare Beneficiaries

Danielle Bartolotta, Health Policy Intern

Although dental care is important to overall physical health, a recent survey found that baby boomers are the age group least likely to have dental insurance, in part because many Medicare plans don’t offer dental coverage. The chart below shows the proportion of different sources of dental insurance among Medicare recipients in 2012, 2016, and 2021, showing an encouraging trend. The proportion of seniors without dental care has declined from about 88 percent in 2012 to 47 percent in 2021. Medicare Advantage (MA) plans have been responsible for the largest increase in dental coverage. The proportion of beneficiaries with these plans has increased from 16 percent in 2016 to 26 percent in 2021. Additionally, some beneficiaries have supplemented their Medicare plans with private insurance to obtain dental coverage. The trend for seniors to supplement their Medicare coverage with private insurance or MA plans that include dental care creates an opportunity to integrate their oral and physical health.

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