It’s far from a done deal, but the $3.5 trillion reconciliation bill Democrats in Congress hope to pass could expand Medicare to include dental and vision coverage. As Fierce Healthcare explains, “an expansion of benefits for Medicare has been a longtime priority for Democrats and Schumer, who tweeted in June that the lack of those benefits leaves a ‘gaping hole’ in Medicare coverage.”

Indeed, a 2019 Kaiser Family Foundation analysis found that about two-thirds of people with Medicare do not have dental coverage, and nearly half of all seniors have not been to the dentist in the past year. And no, that’s not because there is no need; among those who had been to the dentist, nearly 20 percent spent more than $1,000 out of pocket.

Dental and Vision Coverage Could Be Added to Medicare Figure 1

The consequences of poor dental health can be significant. As we explain in a December, 2017 blog post, there is a strong connection between dental health and overall medical health. For example, gum infections can cause or increase the risk for conditions like Heart Disease, Stroke, Diabetes, Alzheimer’s, and more. 

Additionally, poor dental health can also lead to poor nutrition, social isolation, and more. In the Kaiser Family Foundation (KFF) study, 15 percent of respondents had no natural teeth, which “can adversely impact quality of life.” KFF explains that this can cause older adults to be “embarrassed about their teeth, avoid smiling, and even reduce social participation due the condition of their mouth and teeth.” On top of that, chewing and eating can be difficult for seniors who have no or few teeth, which can cause other health issues. This “also affects nutrition because people without teeth are more likely to substitute easier to chew foods that are high in saturated fat and cholesterol for fruits and vegetables which are harder to chew.”

One of the benefits of a Medicare Advantage plan is that it may include access to dental coverage, either at no extra cost as part of the plan or as a separate benefit for an additional fee. 

However, seniors do not have to participate in an Advantage plan to get dental coverage. Most individual dental plans are available to people regardless of age, though there may be a waiting period for major services. Just a reminder that AHCP does offer a number of dental and vision plans to help your clients. 

What will ultimately happen with the reconciliation bill and a possible expansion of Medicare is anybody’s guess—we’ll have to wait and see. Until then, please make sure that you’re asking clients the right questions to identify coverage needs and, if they do need dental and/or vision insurance, offering solutions that can help them today.