Most Medicare Advantage plans cover both dental and vision services. So, while FFS Medicare does not include dental in its basic benefit, coverage is available to most seniors at little or no additional cost in premiums.
2
My Medicare Advantage plan, like the other ones available to me, offers to "cover" dental care at such puny rates and such high premiums ($60 a month) that it's not worth having. The only thing it pays for is exams. Other procedures are covered at no more than 50% with a MAXIMUM annual payout of $1200.
Going to Mexico is a better deal, and you get a winter vacation to boot.
3
So absolutely true. This year my husband and I spent about $15,000 on dental care. We quickly exhausted our dental insurance. Nothing drastic: just fillings that had worn out over a lifetime and now had decay around them, some root canals for one of us, and crowns.
3
Spread dental hygiene awareness? Forming habits seem much cheaper than dealing with rotting teeth from years of neglect. For something so preventable I wonder why it's an argued issue.
3
It's not as simple as that. Sure, dental hygiene helps as does not eating and drinking the kinds of things that promote decay. But a lot of it is genetics. I have two children: one has rarely ever had a filling; the other (the world champion of dental hygiene) gets cavities no matter how often she flosses. One got her dad's genes; one got her grandfather's genes (first cavities in his sixties).
5
This article is old by web standards now, but I gotta say that if you've ever been to a Medicare dentist, I feel sorry for you. My coverage only offered few options, each worse than the last. I opted to go to a "dental center", Western Dental. What a chop shop that was. Assembly-line dentistry, dirty exam and x-ray rooms, assistants who did not know how to use their tools properly, terrible bedside manner.
Even the small amount of dental care offered by Medicare is usually provided by subpar dental offices.
8
Great article. Thank you.
2
My own dentist serves at a clinic for the indigent but he is in the vast minority. Dental practitioners seem t be a rapacious bunch who insist on payment upfront. They would fight any attempts to include dental care in Medicare. It seems to me that even a ten percent increase in the cost of Medicare would be welcomed by tens of millions if it brought them some (not cosmetic like tooth whitening) dental care.
6
Hit the nail on the head. Rapacious they are. The cost of dental care is through the roof when in fact due to fluoride, electric toothbrushes and flossing the occurrence of cavities has got to be down. I would say in 30 years costs have quadrupled. If health insurance companies refused to pay those prices wouldn't that trim the wings of the greedy dentists? I have never had dental insurance, but have paid out of pocket all my life. Current costs, however. have priced me out of the market. I wonder if Cuba would be an option
2
It is a real issue
2
We see repeated comments about what someone else should do for you or pay for you, but very few comments about what responsibility one should take for themselves. I just checked Amazon and you can buy 12 Colgate toothbrushes for $6.95 and dental floss for 98 cents. The problem with them is that they only save your teeth when you use them. The government could provide insurance that pays for someone to come to your home, dispense the toothpaste and brush your teeth for you.
2
Spare us the GOP rhetoric. If you think even the most well brushed and flossed teeth of your average 65 year old does not require costly dental work in order for those teeth to last another 20 years you don't know what you are talking about. Fillings oxidize and teeth crack requiring very costly crowns. Over 75% of those over 65 have periodontal disease. Reasons for this are numerous, but clearly not just neglect.
6
NHC please don't lecture people about toothpaste. If you have a dying root no amount of toothpaste and dental floss will cure it. That is as dumb as saying if you drink cranberry juice your bladder infection will go away. Or, if you do yoga your colon cancer will suddenly go into remission. Sounds suspiciously like a certain person in the WH. No facts just bluster.
6
Manual toothbrushes don't work nearly as effectively to prevent dental disease as electric toothbrushes, yet over many years I have never had a dentist acknowledge that or recommend or sell electric toothbrushes. They send people home with the regular old-timey brush stick . Older people with poorer hand and wrist mobility could especially benefit, but I think dentists don't much care for them for this very reason.
If only toothbrushes could cure NHC's problem.
Get all new dental grads with dental school loans. Cut all dental fees in half for Medicare. Tell the grads you'll forgive their loans. It's really not that difficult.
6
Here's the deal. Dentists in this country are incredibly skilled. Unfortunately they gouge on prices. They dont function on the free market. That can be very easily changed and I know how to do it.
8
Some of the comments here about ROI and old people are not worth it are appalling. Before you hit submit, read your comment out loud while looking at yourself in the mirror. Would you say this to your friends at work? Some people here really disappoint. The measure of a civil society is how we treat the weakest among us. Just stop and listen.
15
Podiatric care also is not covered by Medicare unless one is diabetic. So until sores, cornsand calluses turn into suppurating ulcers, they are not.
2
Yes, dental care is essential healthcare. And it’s expensive. And no dental insurance I’ve ever had has been useable.
The NIH says missing teeth increase the risk of death — by as much as 30%. The American Society of Nephrology says adults whose severe periodontal disease goes untreated for 5 years develop chronic kidney failure 4 times more than those with healthy gums. The American Heart Association notes an association between periodontal disease and cardiovascular disease. Other studies link gum disease and untreated cavities to strokes, diabetes, and dementia.
Yes, Medicare should include cover dentistry adequately. Americans are sick earlier and dying younger because it doesn’t. Ditto for no coverage of hearing aids — those with hearing loss are at greater risk of social isolation, increasing dementia, increasing mortality.
NY Health (Gottfried/Rivera), Improved Medicare for all (Sanders/Ellison), and other single-payer legislation (in process in two dozen states) ALL include dental care — and vision and hearing — because, as NY Assembly Member Gottfried puts it “teeth, eyes, ears, brain are ALL essential body parts,” and good health requires their care be covered without financial obstacles.
16
To the commenter who posted that on their travels that Canadians have rotten teeth. 1. Many working Canadians have good employer based dental. 2. BC dental rates are reasonable. Indeed I had read that Albertans were coming to BC for dental work as their fees were so high. Recently I read they had lowered them. 3. I do not obviously know where you were but if you came into Vancouver on a cruise ship and walked into the Gastown area this is adjacent to one of the most Godforsaken areas in Canada...the Downtown Eastside. Millions of dollars are poured into that area yearly with seemingly no effect. Indeed it gets worse and worse. For a while there was a tent city in a park which our mayor refused to do anything about and ruined the annual Japanese Festival...the Powell Street Festival that year. One hot summer day within the last few years driving along Hastings Street was reminiscent of pictures of Central America with the sidewalks lined with people sitting on the sidewalks leaning against the builfings.
Vancouver contrasts empty foreign billionaire owned condo towers with this hideous third world poverty.
Me, I am a senior who got my start before the insane foreign realestate bubble.
3
Fat chance of ever getting Medicare dental coverage when the present House is intent on cutting the plan as it NOW stands.
11
America can be a very cruel country. Denying elderly decent healthcare is one example.
And it’s only getting worse with the current cruel “President”.
Hoping for turnaround elections in ‘18 and ‘20. Only with real change is there any hope that Medicare might step up & provide dental care.
10
Dentists here charge exorbitant fees. Endodonists even worse. Medicare should reimburse dental procedures done at Mexican and other off shore clinics. The clinics could be pre-screened for quality and standards.
6
What other options are out there now for Dental Needs? It doesn't sound like we have time to wait for this. I know my Grandmother uses www.1Dental.com and think she saved a lot of money, but is that available for others on Medicare?
1
The problem stems from the high cost (both dental and other types of medical care) rather than just coverage. Medicare is a type of insurance, and taxes/premiums would hypothetically have to be raised by the same amount in order to cover dental, as would be paid out every year. High prices compared to regular peoples incomes are the underlying problem
5
I have a lot of empathy for the average American with regards to accessing any kind of medical care. And I have read many articles regarding lack of access to care , but for the life of me, I can not understand why citizens keep voting for politicians who support huge military budgets and tax cuts for the wealthiest. The ACA had problems but it was a step in the right direction and the candidate that vowed to abolish it won. Man aof the poorest states keep voting in tax cutting , military loving and anti health care candidates. There is a limited amount of money when huge military budgets and tax cuts are popular .Yet articles like this elicit overwhelming support for improving healthcare but Republicans control the house and Senate. Ronald Regan stated that Medicare would destroy America. He called it a huge threat to our freedom in the 60’s and it’s an extremely popular and successful program. The key is to turn out the vote for politicians who will support affordable healthcare.
17
Medicare takes in only 50% of what it pays out. The rest comes from the general fund which the public doesn't see. Any give away program is popular. Military? Its a nasty world and the bad guys are not going away. Radical Jihadists exist. Russia and China exist. Threats to the US are there. Poor spending as to defense does need to be addressed. Healthcare is expensive and never will be cheap. New meds, new procedures always coming on line. That next generation of CAT Scan technology will cost how much? How much will it cost to finally find the cure to cancer?
2
Dental insurance isn't just a problem for the elderly. I buy my own health coverage as a small business, and I gave up dental when I was offered a plan that limited me to $500 a year in reimbursement - for total premiums of $750! No wonder Medicare recipients have bad teeth. They can't afford to take care of them when they're working.
17
That plan was a shocking ripoff! to pay more in premiums than you get in coverage? Yikes!
Thank goodness you read the small print!
4
One would think that the lack of affordable dental care for many Americans would shut down the ridiculous argument that if people paid more out of pocket for their healthcare bills, care would be more affordable.
But perhaps healthcare economists are too self important to use data from other sources to draw their conclusions. It seems that if they haven't come across the evidence from one of the very own studies, it's not worth noticing.
3
Important to note, medicare DID cover dental care until Ronald Reagan cut it. Another republican gift that keeps on giving.
43
We, the seniors have prescription benefits, which are deducted each month from Social Security. Most prescriptions actually cost less at the pharmacy without insurance. I would happily give up this so called prescription coverage for dental insurance. I paid out of pocket this past year, about $5000 for dental work, some of it redundant. I have always taken good care of my teeth, but time takes it’s toll, and I have always known about the connection to overall health.
13
No. Medicare should not include dental. Learn to save some money for a rainy day. If you can't do it, how do you expect our government to do it. There is a deficit of over $20 trillion, let's get that under control before creating another entitlement we can't afford to pay for.
5
Some people don’t earn enough to save sufficient dollars for a rainy day fund. Others may exhaust their funds on other emergencies, be it for health care, transportation or home related. The federal government, and states too, have the power to pool resources so that everyone might give a little in order to gain access to care when in need.
The federal government is on the spot? Perhaps it too could have saved for this rainy day by not giving tax breaks to those least in need, or asked us all to shoulder wasteful across the board spending, especially as to defense budgets.
14
You are either luckily healthy, on the younger side, or rather naive. I am a physician and, like everyone else, also a patient. You can save all the money you want yet a single hospitalization, accident, or continual dental problems can wipe all or a lot of it away pretty quickly This happens even if you have health insurance as it is limited in what it can cover. In terms of the federal deficit, if we stopped fighting wars and engaging in skirmishes without a defined end or mission, a fraction of the millions/ billions we spend per month on war would more than enough to cover dental, medical, vision, prescription, and even long-term care for our citizens.
Two decades ago, when my father worked in the defense industry, a single non-top-of-the-line fighter jet cost $35 million. Buy 2 less jets and you could probably pay for all Americans' dental costs in a year.
18
How do children of single mothers receiving government subsidies “learn to save” money needed for rents, sky high in major American cities, food, transportation, etc., “for a rainy day” dental problem, extractions, peridontics, orthodontic, prosthodontic, dentures, implants...?
1
At least dental coverage is a "thing". And vision coverage? It's a "thing", too.
I am going deaf. But I am on my own to finance my hearing aids. Our disability is utterly disregarded. Hearing coverage is not a thing.
17
The NYTs continues unabatedly bashing providers and government entitlement programs. The first step is federal tort reform to lower overhead so providers can offer low cost affordable care. There are plenty of dental school clinics nationwide that offer care based on what patients can afford. Finally low income patients have to educated on how to budget for preventative dental care and to be compliant and responsible with their health, dental and otherwise.
3
It's not a question of education, it is a question of having the budget for unexpected expenses. The best way to budget for these things is to have a tax that is taken out of one's salary and dedicated to paying for healthcare.
4
Where is the evidence that shows excessive malpractice premiums are a primary reason we have a shortage of dentists, or the cause of high prices for dental services? Talk to me about equipment costs perhaps.
As for clinics operating within dental schools, the problem is demand for discounted services is too high. These clinics don’t have enough chairs for the need. And they are too far away for many, especially those in rural settings, to access.
One way around this growing crisis may be to allow mid level dental professionals, EG, hygienists more latitude to provide preventive services in more settings. Low cost cleanings and dental exams in medical and community health/senior centers could make a world of difference.
3
Ok, why don’t we tax enough to feed all that are hungry.The tax and spend mentality didn’t fly this last election cycle and may not for the forseeable future. How about a little personal responsibility for our own health.
All dental coverage is awful, at least in my experience. All the years I worked, I had great health insurance. But, the dental coverage was limited to 50%. Not wanting to end up with a huge bill, I started really taking care of my teeth. I have brushed and flossed 2x a day, every single day for years, and it has made a big difference in my dental health. I'm retired now, and I pay for a cleaning once a year and have had great checkups for many years. Start good dental care early, and it won't matter whether you have dental coverage when you reach old age. I have all my teeth, including my wisdom teeth!
13
The dentists in NY charge sky high fees regardless of their quality of service or outcomes. Ratio is almost 10 to 1 to MDs. Any MD gets much more training and retraining however. ADA doesn't discipline the scam artists. There isn't even disclosure about what the fees will be for the same procedures from dentist to dentist. For example an implant crown can involve 5-10 procedures and parts. There is no consistency. I once had a porcelain crown put in without even being offered a zirconia and was informed once the crown was inserted. Many dentists get away with abysmal patient communication. I had a crooked periodontist who said it his not his job to take xrays when I had an issue. He said "go see a dentist.", the arrogance and neglect. I fired him months later after the issue was a large festering infection giving me chronic ear pain which was uncovered by his replacement. In other words patients are almost helpless. Medicare would have weeded them out with satisfaction surveys.
4
A number of posters below have also pointed out the lack of hearing aid coverage in Medicare.
Last year Congress passed and the president signed into law (on August 18, 2017) the FDA Reauthorization Act that contained the Over-the-Counter(OTC) Hearing Aid Act.
This hearing aid section requires the FDA to study and put together guidelines that will allow for consumers to buy hearing aids OTC, without having to go to a specialist MD. This could reduce the cost of hearing aids significantly!
See:
US Senate Passes OTC Hearing Aid Act as Part of FDA Reauthorization Act of 2017
Published on August 4, 2017
http://www.hearingreview.com/2017/08/us-senate-passes-otc-hearing-aid-ac...
6
thanks 4 your excellent report
this is a major problem
its also worth noting that when you cant afford 2 properly care 4 your dental health, it leads to social isolation & depression
8
It may also lead to reliance on pain meds
1
This country is so sick in its soul... Health care w/o dental, vision, hearing, whatever else coverage... Really? Just another way to keep us slaves to the 1%...
20
Canadian single payer does not cover dental work, vision care or prescription drugs.
1
Not completely accurate. It depends on the province.
If dental coverage is added it will have to include high enough reimbursements for treatment to entice dentists to treat these patients. DentiCal fees in California have been so abysmal for so many years that patients are very hard pressed to find a provider that will see them. Even then the wait times for an appointment can exceed six months. There is little use in having coverage if providers will not take it.
9
I have dental insurance. Even with it work we (wife included) will do in a few weeks will still cost us almost a 1000 dollars out of pocket. We are among the well off retirees. But for most people I know retired they could not afford it. We do need a dental benefit in Medicare.
8
50 years ago most middle age people and seniors had all their teeth removed and dentures placed. Now this generation wants to keep their teeth ,unfortunately , to save teeth at middle age or after costs 50k dollars or more .I don’t believe the government will take on this expense. The insurance model will not work for dental care. The premiums would be unaffordable .
2
I have never understood why dental and vision care were not included in most insurance plans. We need both to be healthy, function and work.
14
What about hearing loss? Why don't we count?
4
It would be wonderful to see once a year basic preventive dental coverage added to Medicare, but I doubt it will ever happen. This country doesn’t seem to be able to coonect the dots between cause and effect in any area.
12
The VA does not as well. And the information that bad teeth can cause other health problems seems not to reach the people who decide about coverage.
5
The VA does provide dental benefits under certain qualifying conditions:
"VA offers comprehensive dental care benefits to certain qualifying Veterans. In addition, Veterans enrolled in VA health care may purchase dental insurance at a reduced cost through the VA Dental Insurance Program (VADIP). Beneficiaries of VA’s Civilian Health and Medical Program—a health insurance program for dependents of Veterans—are also eligible for VADIP.
Services offered through VADIP include diagnostic, preventive, surgical, emergency, and endodontic and restorative treatment. Veterans and other beneficiaries who choose to purchase VADIP pay a fixed monthly premium and any copayments required for coverage, depending on the type of plan selected."
After 3 years getting excellent and economical dental care in the Philippines I returned to the US for an extended stay. I needed to get my teeth cleaned as part of my scheduled program of preventive care. Do you think you can find a dentist in the US who will just clean your teeth when you need it?
No you cannot. I called around. Every dental office required that I submit to a complete exam including X-rays if I wanted them to clean my teeth. Of course this would add hundreds of dollars to my bill.
Evidently the dental lobby has even encoded this into law. And they've locked up the hygienists, too, who can't set up their own businesses offering convenient and economical services, but by law have to work under the auspices of a dentist.
So here is yet another reason for our poor dental health: dentists and their fee-pumping practices.
23
The key piece of the puzzle that you are missing my angry friend is legal liability in the American system. If a dentist sees you to clean your teeth and you have a condition that is not detected visually, the dentist can be on the hook for hundreds of thousands of dollars (think lung cancer metastasis to the jaw - only detectable by radiograph - and yes, I have seen it). Most Latized countries do not operate under English Common Law. We do.
4
Went to see my primary care physician a while back with a stiff neck that wouldn't go away.
He diagnosed the problem and prescribed treatment. He didn't insist on putting me through tests and physical exam first, just in case I had cancer.
Dentists evidently claim they have to charge us hundreds of extra dollars for un-requested procedures to protect themselves from liability. This is an odd message to send the market, when you think about it, and somehow it just leaves me with this nagging suspicion that it may be motivated more by their interests than mine.
2
Your friend’s anger may be related to jaw pain caused by excessive teeth grinding resulting from listening to the lie that high dental care prices are due to malpractice premium costs. Facts may be helpful here.
1
This article makes excellent points. But I'll go further... why start advocating for dental coverage with Medicare? More 'inverted pyramid' medical spending in this country where we finally award people medical care -- often expensive -- only once they're elderly.
Wouldn't it benefit everyone to have better dental coverage? Most medical plans include no dental at all. It's often separate and expensive in its own right. It also comes far short of covering a lot of the expenses incurred. So people either have less coverage than they often need or in many cases none at all.
Don't people younger than 65 deserve options for dental care too?
Ad as a benefit to adding advocacy for all ages to receive it -- the expenses associated with elderly dental care may even be mitigated as they would benefit from better preventative care all along.
Let's stop the advocacy of old vs young, rich vs poor, etc. and start looking for solutions that benefit ALL people.
28
Medicare also doesn't cover hearing health. Federal studies show 30 million older Americans could benefit from hearing aids. The average cost (for one) is $2300. Most people need two. How many seniors can afford $4600 as an out of pocket expense?
Untreated hearing loss is associated with social isolation, depression, a higher risk of falls and cognitive decline - including dementia.
All these cost Medicare a fortune to treat. It seems a foolish economic policy. As is the refusal to cover dental care.
19
There is a limited pot of money to spend. Even if you pay doctors nothing at all, we would still run out. Yet we spend fortunes on illegals who show up here with problems- most patients in nyc hospitals are immigrants, some legal some not. Why are we bringing in people and paying for their care when we don’t have enough for taxpayers? In addition, we spend ridiculous amounts on end of life heroics. No- most doctors are repulsed by this; it is patient and family driven. We must limit what we spend on Medicare beneficiaries to what is reasonable (comfort care, not futile life extending treatments), and control all immigration, legal and otherwise, to true refugees and those who can afford to live here without direct taxpayer support.
13
Do we ever run out of money for the military? Doesn't that money come from the same place money for Medicare is found?
16
And yet we have money to burn on the military, continuing wars in the Middle East, tax cuts for the “best people”, and other absurdities - rather than providing decent care to everyone in this country.
21
Jmc- tax cuts mean that people get to keep more of what they earn. How is that “absurd?”
The sad fact is federally funded health care programs manage dental care as essentially and equally prioritizing as other medical problems.
However, there are means and ways to provide solutions to this problem:
https://www.medicareinteractive.org/get-answers/medicare-covered-service...
The alternative method of dental schools presents a wonderful way of keeping the patients within the realm of great dental health care at low costs!
PACE or Program for All- Inclusive for the
Elderly coverage by Medicare/ Medicaid provides adults with dental care while admitted in rehabilitation
Finally, when all else fails, the Community Health Centers offer reduced fees or no costs for dental treatments with the caveat for long waits and crowded waiting rooms.
2
Annabelle Tureaud: 2nd attempted reply: Tufts dental school student service in 2014, was charging more for dental implants than a leading New England Dental discount chain (Aspen Dental). Student dentists require a patient for practice dentistry for at least a year or two. Community dental operations in places like Maine and Louisiana to serve acute dental conditions generally cost the same as private dental practices.
The alternative to present dental provider service without employer dental insurance or federal medicaid is for mandated dental pro bono requirements to uninsured unemployed patients. One solution might be an annual pro bono service weekly requirement of all private practitioners in return for dental school tuition Federal loan forgiveness. (Dentists like Dr. Jay Grossman (www.homelessnottoothless.com) of Los Angeles, CA., and Dr Eugene Sakai of Washington State’s Freed Dental clinic have dedicated programs of pro bono dental service).
Some dental schools like New York University Dental School provide a week or more of free dental service from student dentists under the supervision of dental professors, a service to parts of poor rural and urban communities. And some private practitioners also donate pro bono service a few days each year. Pro bono dental service of all dentists in return for federal dental school tuition loan forgiveness is another remedy.
1
Adding dental coverage to Medicare would be a very positive step. However, I must point out that it is also true that people over 50 are very prone to hearing problems, and Medicare does not cover hearing aids at all. Including help with the cost of such durable aids would be a major step, also, and help thousands of elderly citizens who live on Social Security.
4
C Co, 2/18th 1st Inf Div, Dong Nai River and Thu Duc, Republic of Viet Nam: 20% of my soldiers had three or more teeth with holes so big that I could pass a straw thru! The dentists in the rear were so busy taking care of their beloved 510,000 REMFs they to work on my infantrymen men if the field.
It took four soldiers with abscessed teeth to equal one healthy soldier in the field in combat operations or under fire. The mortality rate for them was three times higher than for healthy troops. Booby traps and IEDs explosives were 80% of kills. Friendly fire was next! Yet still, “Teeth are not an health issue! We don’t have time for the troops you send to us!” was written as they sent them, untreated, back to us.”
Both of my two company commanders were superb and, despite the damage to their OERs, they fully backed my strategy. Abscesses on the neck were definitely considered medical and suitable for same day treatment and return. So every other or so, near the end of daylight, I called in an evac helicopter for evac of three soldiers with ‘abscesses’.
Since we were “swamp rats’ this was expected and considered a reasonable number for 220* infantrymen.
Reality. Always the teeth were extracted, commonly leaving them with more than a quarter gone. Still, they quickly became much healthier and much less likely to trip a wire or be shot. I will always admire both of my commanders. UAB Medical School trains its med students in emergency dentistry. And their dental school in emed
8
Hearing loss that can lead to Alzheimer's, depression and tension induced medical problems is another condition that is almost completely ignored by Medicare, except for evaluations. Forty eight million people have some form of hearing loss. A large majority can't afford to buy hearing aids necessary to remedy their hearing loss because Medicare doesn't cover their cost.
4
The lack of dental coverage in Medicare is like 'shooting your own foot', and making the overall healthcare costs more expensive in the long run, similar to being petty and shortsighted in providing for adequate care of mental illness (including drug addiction or dependency), separate from the usual diseases covered as a matter of routine. Let's wise-up, it's later than we think, and the cost of neglect keeps mounting. Wealth without health is stupid indeed.
4
"Making a case for this in the political arena would not be easy, though. The initial cost would be an inviting target for politicians who express concern about fiscal prudence." You mean the very same politicians who added $1.5 trillion to the national debt with their tax plan favoring the uber-rich and scamming the rest of us? And what about Trump's $1.3 trillion dollar giveaway to defense contractors for nuclear weapons that threaten not only our own national security but the very existence of life on earth? Please, don't throw a bone to these evil jokesters who pretend to be public servants but in reality are in the pockets of those who care for nothing but their own short term financial gain.
15
The problems are deciding the levels of dental care important to overall health, preventive, restorative, palliative, and establishing controls to prevent fraud and abuse. And the massive problem of financing such a program.
An anecdote supporting the relationship between dental problems and overall health: F.W. Woolworth loved rich sauces and deserts. Woolworth was terrified of dentists, and is not known to have seen one as an adult. His teeth became rotten and he developed septicemia. Woolworth died at the age of 66 from complications of dental disease.
2
Coverage for oral cancer is peculiar. Surgery was covered, radiation treatments were covered, however, the radiation treatments also resulted in bone loss and the very real prospect of severe infection and loss of teeth in the future. Coverage for these impending problems is considered a dental issue, so not covered by Medicare. Reconstructive surgery for other types of cancer is covered, why not oral cancer?
8
Dental lobby strikes again. Keep how these lobbies buy Congress people when you head to the polls this year.
We need to fund political campaigns out of public monies and eliminate contributions from corporations and the public.
3
Here is the way to solve this dental dilemma for Medicare recipients. The government should have dental clinics for seniors on Medicare. The dentists are reimbursed a reasonable salary and are government employees. This would be similar to VA system for dental benefits but not in a hospital setting.
If this administration can fund billions of dollars for a stupid, ineffectual wall, than they can certainly find dollars to fund dental clinics for Medicare recipients !!
14
This would work well. But the donor classes that get politicians elected have plenty of money for their dental care. And all a politician has to say is this is socialized dentistry and people will reject the idea. The politician who got CHIP passed which is great dental care for children lost to Trump.
3
One aspect of this terrible lack of dental coverage is social isolation. When your teeth are reduced to broken shards you become very reluctant to leave your home.
I've had Medicare for years due to a disability. I also have Medicaid because my income is so low, but Medicaid only pays copays for procedures covered by Medicare, dental is not covered.
I always had beautiful, straight, healthy teeth, that is until I turned 58, then things changed rapidly. I am now 62 and I have lost part or all of 7 teeth in the past 4 years. All of my teeth have large cavities. Most days I experience pain in one or more of my teeth. I never use pain killers for fear of dependence, instead I swab with clove oil. Eating is becoming ever more difficult.
The pain, constant risk of infection, and dwindling food choices are difficult, but it's the shame I feel over my appearance that is the most devestating. Nothing says poverty like bad teeth. I rarely leave my apartment now, even avoiding family gatherings out of embarrasement.
No one in this country should have to choose between housing and dental care.
37
Here, in a nutshell, lay the groundwork for a winning platform for Democrats.
12
It doesn't cost that much to get your teeth cleaned every 6 months. Get rid of your cellphone, cable, restaurants, movies, sports, etc...........and you will have plenty of money to get your teeth cleaned.
9
If only that was a panacea from teeth problems
1
Driven--Get rid of $1½ trillion in tax cuts for the filthy rich and we can pay for EVERYTHING we need in our country. No need to make such nominal, everyday sacrifices, when the rich never do.
14
"Get rid of cellphone, restaurants, movies. sports, etc....." This is a very short sighted and condescending statement. It has been many years since I could afford movies, cable, a computer, theater tickets etc. etc. I do have a cellphone with a limited wireless plan, it is my only access to news and communication. Giving up my phone, food and Housing would not come close to paying for the $30,000 plus required to deal with my dental problems.
27
I was shocked when I asked my VA doctor what the VA would cover in case of oral type injuries or cancers. Kind of irrational to say all of the body is covered except the mouth and teeth. I wish the MD's and the Dental doctors would just settle their feud and let the people get the care they need.
Hugh Massengill, Eugene Oregon
6
Curiously, Mexico’s dentists have found a great economic niche market in dental tourism. Americans and the Mexico Government ought to invest in the Mexican competition with American dental providers and dental insurers. Next to none of American dental insurance programs offer any immediate full dental coverage like one’s insurance policy for auto, home or job accident insurance policies.
If you have an auto accident right after you sign your auto coverage policy, you’re covered for accidents in the policy.
For American dental insurance policies, if you need implants or major dental dental implants, orthodontic, prosthodontic or other oral dental surgery, you must wait six months to a year after your policy goes into effect before dental insurers cover as much as 80 percent of your costs.
In Canada, the so-called universal national health insurance for dental work is a nightmare, with no insurance coverage offered for most Canadians except for children and in some cases their mothers. Unless most Canadians have employment coverage for dental care, they are out of luck. And a visit to most Provinces, for any length of time outside of a drive-thru or cruise ship stopover, shows the result of Canada’s government neglect of dental care for most Canadians.
Mexican affordable dental care is First World while Canada’s dental care is Third World— or the kind one imagines of fictional characters in a Charles Dickens novel like “Oliver Twist.”
7
Bayou--We can learn from others' mistakes and successes, when we organize our national universal health care program.
4
I pay $336 a year for dental insurance with an annual cap of $1,000 and no coverage for more expensive procedures like implants and caps. The only reason I buy it is that the insurance companies negotiate reasonable fees with the dentists. Without it, a routine exam, for which the insurance company pays about $150, would cost me more than $300.
This is a scam and should be illegal.
16
The real benefit of dental insurance is not what the insurance company pays (very little), but the negotiated fees. We’re never going to have widespread coverage for implants and other expensive procedures.
4
You need to shop around. Most dentists will discount heavily for cash.
I’ve thought for years the biggest screwup of the ACA was not beginning with dental care for all. It would have helped everyone, lowered ER usage and such, and helped prepare for the ACA as a testbed because dental costs are more standardized and predictable.
7
The reason a prescription drug addition to Medicare passed was that its primary purpose was to support the outrageous prices the drug companies charge Americans. For many, if not most people, they can get their drugs cheaper from Canada and other foreign countries than it would cost them to sign up for Part D.
Another reason the plan passed was that it is not really a Medicare plan, but simply a way to introduce the waste and inefficiency and profits of private insurance companies into Medicare.
Any Medicare plan that was for the people on Medicare would have had provisions for lowering prices at its heart. At the very least, Medicare should have been allowed to negotiate prices.
Make no mistake, the bill setting up the Medicare drug program should have been titled, " The Drug and Insurance Company Welfare Program."
6
Dental problems can threaten your life. We don't talk nearly enough about it. Medicare should cover dental AND eye care. Total health, longer, better lives. BTW, I've had at least 3 surgeries where I was given opioids for the pain. I took them for about 2 weeks, each time, then switched to aspirin. And, I have an addictive personality--I smoked for 30 years, and am an recovered alcoholic. have trouble controlling my weight. Not everyone gets addicted to pain medicine. Let's not make non-abusers pay for the weaknesses of abusers. If you need it, you should get it.
5
You need to save some money for retirement and buy supplements dental and vision plans.
If you don’t, then you won’t have coverage.
You have had 45 years to think about this issue.
What was your plan at the end of those 45 years?
8
While this may be unpopular in some areas, the reality that fluoridation in drinking water, vitamins and toothpastes have created a generation with much healthier teeth. I understand that there is anti-fluoride sentiment, (much like the anti-vaxxers), but science is science.
9
I have read numerous reports of people who got started on opioids when going to an ER for dental pain.
2
Look for a good dentist that will take cash and don't ask for a receipt when you pay cash.
2
Medicare doesn't cover dental, vision or really drugs because the republicans want those carve-outs for private, for profit companies. There is no other reason and it's disgraceful.
20
Add hearing aids to this list. There is good research that shows how detrimental to mental and physical health hearing loss is but plans do not cover this cost which is usually $2,000 and more. The dentists and audiologists have rediscovered a cash cow!
18
The NYT published a review of Mary Otto’s wonderful book “Teeth” on March 23, 2017. I wish this had been mentioned,in this article. Required reading for anybody interested in this extremely important topic. Cordoning off dental care from the rest of medical care is a huge and ridiculous problem in this country. I remind my dentist and primary care physician of this whenever I see them as my own little way of contributing to the cause. Ignorance about this is appalling. My dogs get better holistic care than we humans do, given that my veterinarian treats not just my dogs’ bodies, but their teeth and gums, too.
13
not just dental, but hearing and eyesight. those are most often health issues that affect people of medicare age.
15
my wife and I have been talking about this for awhile. We used to wonder how people go around without teeth. Now that we're older, we understand. This year our dental bills will be well over $20,000. We were actually quoted a fee of $12,000 for one implant including the extraction and crown. The prices are as absurd as Manhattan real estate.
17
Implants are really deluxe treatments, though. Before them, people pulled bad teeth and got dentures or bridgework.
Your dental bills were that high because you opted for super deluxe cosmetics.
1
I had a Medicare Advantage plan that carried dental benefits. Those benefits turned out to be useless because only a limited network of dentists could be used and the covered procedures were limited. For instance, a cleaning did not include scraping by hand of the teeth. The insurance companies contract with the chain dentist companies you see at the mall -- no good ole', trusted family dentists were involved. So, where do we go from here? I ran up $10,000 on credit cards for dental work, hoping to find a job to pay the bills. I have not found a job and my mouth hurts due to an extra $5,000 of work needed. Other teeth are looking about to need care, this is not likely to end.
NY Times, please lots of coverage on this topic!
14
Nobody will accept contracted rates because they are far too low. Control malpractice, stop paying for immigrants and maybe there’ll be enough left over
5
I am not aware we are paying for immigrants, and control over malpractice is in the hands of the doctors - they are ones who commit malpractice. So, not much money there for dental care. Maybe, we should not give tax break to corporations, but use this money for dental care.
12
Give me a giant break! Mexico and Costa Rica have excellent dentists and dental care for a tenth of what we have to pay in the U.S. Our elders NEED dental care, new glasses and hearing aids. Are we really time traveling backwards in this country?
3
Has anyone evaluated the link between a semi-permanent oral bacterial infection caused by the lack of regular dental care had on the rise in dementia and Alzheimer's? It seems like a raging infection mere inches from the brain hanging around for decades might be have a causal link somewhere. If so, preventative dental care would be cheap when compared to long term dementia and Alzheimer's care.
13
There is no connection and Alzheimer's is not an infection.
We can thank the ADA for not wanting appropriate coverage for dental work in this country, and I’m sure in Canada as well. They are as powerful a lobby as the AMA, and they didn’t want the cash cow to be regulated. The great irony today is so many young adults have good teeth, as their parents made sure they had proper dental care and check ups, as I did with my children, that the dental industry is left with fewer young patients and the majority of older patients can not afford the outrageous costs of dentistry today. Plus, with new innovations such as cavity prevention thru sealants, this problem will result in even fewer patients for dentists after the older ones have passed away. If the dental cartel had only been less greedy and more open to comprehensive plans, this all could have been avoided. Also, even though Canada doesn’t have plans for their health care system, the prices are far more reasonable than in the states, same for U.K. If you go over there and aren’t covered by the National health plan.Being Scottish and “blessed” with the poor teeth of my ancestors, I will avail myself of these services, eventually!
8
Dental care is not cheaper in Canada; in the UK, it is of very low quality. Buyer beware.
1
Concerned Citizen: you are posting a lot with lots of bad info. Consider the notion of UK having low quality dental care ... Actual public health studies of dental care show the UK has less decay than the US. Among children, a WHO report says UK kids have better dental health than kids in France, Spain, and Sweden; about the same as Germany, the Netherlands and Finland. Now let's look at the US in that same report: avg US 12-yr-old has 1.2 decayed, missing, or filled teeth; UK kid has half that. In UK 70% visited dentist at least once in 2012; in the US, only 40% did. In the 16 developed countries, UK came in 3rd for teeth health; US came in 13th.
Thanks for the informative article.
I'd like to point out a different perspective on costs. If the costs of regular cleaning were covered 100% by insurance, this would encourage people to get their teeth cleaned more regularly, and in the long run, would result in far lower overall healthcare costs. It could also be a kind of carrot/stick system whereby people who failed to have regular cleanings had to pay larger co-pays for more expensive procedures, while those who were careful to get regular cleanings would receive higher coverage.
Just a thought.
6
Great article, but paragraph 9 needs some better wording.
Medicare Advantage plans are not "private alternatives to the traditional program ." They are private ADDITIONS to the traditional program.
Traditional medicare covers 80% of most (but not all) outpatient-type expenses. Medicare Advantage Plans help with the remaining 20%. Some of these plans add in vision, dental and/or Part D (Rx) insurance.
Bottom line: whatever you pay in monthly premiums for a Medicare Advantage plan, you'll ALSO pay $134.00 a month or more to Medicare.
7
Everyone but the indigent poor must pay the $135 premium for original Medicare Part B. Only Part A is "free". The $135 is taken directly from your SS check.
Medicare Advantage typically has no premium, or a very low premium. Instead, you pay small copays and use "in network" doctors. The cost savings is dramatic.
If you live near the Mexican border, check out dentists in places like Tijuana. I have friends who regularly go to dentists there and receive excellent care. The experience my friends had, was with a dentist who was trained at a US medical school, had a practice in San Diego, but moved it to Tijuana to avoid the high costs of insurance, rent, etc. Other friends have received really good care in Thailand and India. Implants in other countries that cost over $5,000 each here, cost in the hundreds across the border.
7
The reimbursement Medi-Care pays is so low that it's often difficult to find dentists who will take Medi-Care patients, and this compounds the problem. We need universal, single-payer health care in this country, modeled after the EU. We really are becoming a third-world country thanks to the policies of the GOP.
10
So the solution, if fees are too low, is to put all patients in that low paying program and force doctors to accept it? You will get the type and quality of care that you pay for
4
Agreed, but we need to look beyond the GOP and hold many Democrats responsible, too, for not endorsing full health coverage for all over corporate sponsorship of their campaigns. (Noting that doctors and hospitals are corporations, too.) Odd, since it is only through such policies that they will get elected as the bastion for the good of the people that they claim to be. Gaining office due to Trump outrage is not a lasting proposition.
A government "by the people, for the people" in an age when corporations are legally people requires extra effort to regain a focus on helping, rather than exploiting, humanity.
6
There is all ways the word of the mouth. If some dentists are not good, they will get no customers and therefore, no income. it's called competition based on merit. Right now the dentists charge high fees and could (and many do) deliver mediocre care. In single payer we at least will be saved from high fees
My Medicare Advantage covers cleanings and exams twice a year. I'm going in for a $1000 procedure to fix a tooth that's mostly amalgam. My healthcare provider is a Community Health organization that provides dental care, my procedure will be covered under their sliding scale program--I'll have to pay 60% and they do allow payments. I mention this because there are ways to reduce costs.
In Arizona, at least, expanded Medicaid Advantage covers dental and provides $3000 per year to get the stuff fixed. When I retired, I used this benefit to get a long needed root canal and a crown to fix a broke tooth. Then they canceled my Medicaid (my social security was too much money.)
I think dental is so central to general wellness, it should be covered for everyone, or a highly subsidized insurance should be offered. We know that that will never happen tho.
7
I have dental insurance provided free by husband's employer as a retiree benefit. While that is good, the annual max is $1500. Anything above that amount or charges that are above their allowance for usual and customary fees is my responsibility. Seniors typically have expensive or more complex procedures. Just one tooth repair/replacement can easily exceed $1500. Add that to the cost of my eyeglasses and you can seee my dilemma.
4
I am a working person whose health insurance coverage includes dental, and the maximum annual payment is $1,500. so that it's not a retiree dilemma alone.
8
Let's look at the EU.
"Oral health care is mainly financed by government-regulated or compulsory social insurance in seven of the 18 countries examined here: Austria, Belgium, France, Germany, Luxembourg, The Netherlands and Switzerland. Providing universal or near-universal coverage by membership of insurance institutions, these systems provide oral health care for about 180 million people across Europe, and almost half of all EU citizens. In the Nordic countries and the UK entitlement to care is typically based upon residence or citizenship, and apart from in Norway and Iceland is provided within a tax-funded and government-organised health service. "
https://www.ncbi.nlm.nih.gov/pubmed/10645683
Now let's compare health care costs with the countries that do provide dental care with the the US:
US - 9507.2
Austria - 5227.3
Belgium - 4839.8
France - 4500.4
Germany - 5550.6
Luxembourg - 7462.8
The Netherlands - 5385.4
Switzerland - 7919.0
Sweden - 5487.5
Denmark - 5199.3
UK - 4192.5
These figures are from the OECD and are for 2016 and are in PPP dollars which takes cost of living into consideration.
11
Excellent comment. Thanks for the research.
Dental coverage is also excluded from Canada’s Medicare. When I was a politician in Manitoba, we had a program providing basic medical for rural school children. We tried to expand it to include Brandon, Manitoba’s 2nd largest city and their dentists threatened to leave the city as kids were their easy money. Government backed down. Then the new Conservative government in Saskatchewan shut down their community college program that trained the dental nurses who performed most of the work to please Saskatchewan’s dentists. I suspect the children’s dental program in both provinces has died a slow death.
6
OK, but you neglect to mention some of those countries have a 65% income tax and a 29% VAT on every purchase to pay for all that "largesse".
Also, everyone of them is wealthy, and all white, and only Germany is a fairly large country. How many live in LUXEMBOURG? or Denmark?
It is easy to give luxe benefits to a lot of highly taxed, affluent white people.
The UK is known for their substandard dental care.
1
CC - I gave bottom line figures for cost. It makes no difference if you pay $100 in taxes or in private insurance premiums or to the dentist. $100 is $100. These countries pay less for health care including dental care.
Please explain what size has to do with it. When corporation merge we are always told about economies of scale.
You might leave out the racist comments. What difference does it make how rich the people are if you provide more and better care for much, much less.
Even substandard care is far better than no care.
In her mid 80s my mother told her dentist to go ahead and give her the $500 implant. But he'd said $5000. She was mad but could pay. Most could not. Approaching my 70s now, I fear the huge cost of dental emergencies. Certainly we should have some coverage in Medicare.
7
Dentures work. Just like a Chevy... not as good as a Mercedes but they work. The long term benefit of an expensive implant for someone in their mid 80s is just not there. It is a luxury. Pay for it or forgo it.
4
Agreed NY Surgeon. Why would you do an implant in your 80's. Crazy
Just a request to remember that Medicare is different for people who are on permanent disability vs. those who are on old-age pension.
The folks on Medicare disability are usually young, and with more robust coverage that includes dental and vision, they might actually join the productive workforce (not full-time, and not enough that the public would not be paying for Medicare, but probably enough that they could pay the heating bill without relying on charity.)
However, the fact is that disability Medicare covers less than old-age Medicare - because there are no Advantage Plans available to people under 65, on disability Medicare.
3
That may depend where you live, as I’ve been paying for it and receiving it for a few years now, under 62. About $72/month, covers annual exam, 2 cleanings and about $500 for crowns. The policy states the benefit covers about $1500/year but my excellent dentist negotiates very well with the insurance co. I did have to search for a good provider as my previous dentist was a rip off and not an approved provider. He tried to charge my 80 year old mother in law 70,000 for work on her already-received excellent implants.
In search of more affordable care over the last five years or so, I've had all my dental work done by students at the UMKC School of Dentistry in Kansas City. I wait for my appointments in a waiting room with as many as 100 other patient guinea pigs, and when I look around it's clear most of them are eligible for (pick one or more) Medicare, Medicaid, Veteran's Benefits, CHIP, etc. So yes, there are obviously big gaps in coverage (and teeth!)
I get good care at a substantial discount at the dental school, but it's also clear that many if not most of the school's patients are stretched to pay even discounted rates. They face choices that can cascade into credit problems or even homelessness -- to say nothing of the fact that it's that much harder to eat properly or afford healthy choices if your wallet -- and gums -- are empty.
15
Vision care is another issue. People who skip routine checkups, which are not covered, may have Glaucoma, Macular Degeneration, etc.
11
My sister cried when she found out how many thousands of dollars it would take to establish dental care and fix long-term problems after she retired and went on Medicare. She is still without coverage and without dental care.
18
So basically...she blew off regular care, reparis and cleanings hoping to dump the costs on the taxpayers once she turned 65.
And that is why we will never have dental coverage under Medicare. If we did, people would neglect their teeth and then expect a full set of implants for $60,000 when they turned 65!!!!
1
Boy, is this spot on! I was just at the dentist yesterday and it's going to cost me $4,000 out of pocket to replace an old dental bridge. I have no choice. Paying for a separate dental insurance bill just isn't in my budget. But then you get hammered for something like this, which isn't really avoidable, when something breaks. I can't just leave things as they are or my teeth will keep moving and my entire bite will be affected.
18
I spent $10,000 last year on crowns, a root canal and routine care. Even had I my former corporate dental care, this wold have been a burden.
5
One other important fact is that even though some Medicare Advantage programs will cover basic services and more, there is often a $1,500 or $2,000 annual maximum. I recently had to have two teeth replaced with implants and the out of pocket costs were in excess of $5,500 because of those caps.
Medicare (and Medicate Advantage plans) should cover both basic services and other procedures with reasonable maximums/deductibles.
5
Not even good corporate plans cover dental implants. I have heard of union plans that cover one implant per year, but that is about it. I think it very unlikely they would be covered under a Medicare plan.
I would ike to see a tax credit for all who incur out of pocket dental/medical expenses in excess of 5% of adjusted gross income.
I used to think a retired person needed a rainy day fund of $100,000 to cover uninsured medical expenses, home care workers, other emergencies etc. Now I think that figure should be more like $200,000 because of dental expenses. This is, of course, in addition one's normal retirement savings.
7
Tax credits are costly and only benefit those with incomes high enough to qualify for the tax credit. Another benefit for the upper middle class and the wealthy that is denied to the poor. Otherwise, good comment.
BTW, one of Canada’s Medicare biggest failure is not covering dental coverage. It’s like our teeth (and eyes) are not parts of our body.
5
It defies logic that medicare does not cover dental work. It is as necessary to fix a diseased tooth as it is any other part of the body. Strictly cosmetic procedures should be excluded, just as cosmetic surgery is currently excluded (except in cases of restorative procedures). While dental costs are generally not catastrophic (like cancer treatment, for example), even a small amount a dental work is catastrophic to someone who doesn't have the money. Dentists can do amazing things today (I have two implants). These advances do not make us a great people. Making these advances available to all who need them would make us a great people.
13
Then you pay for all those people who need dental help.
3
In reply to Driven, Yes, of course I'd be willing to pay to help those who are ill and in pain. The burden should be shared fairly in taxes or by income based contributions as with medicare and social security. If you were in pain, wouldn't you want someone to help you? Who are we as a society if we don't do that? I spend a great deal of time traveling to other countries. America is certainly one of the wealthier countries on the planet. We can afford to take care of our sick. You might need that help someday.
2
Thank you for advocating for this important aspect of health care. Addressing the connections between oral health, disease progression, and quality of life are essential. We faced yawning coverage gaps with my mother, and we are now struggling to meet my father's needs. Through him, I have learned that his Veterans' benefits (from his status as a Korean War veteran) do not cover his dental care. The most "cost-effective" treatment plan involved extracting 8 of his teeth, which we did not do, despite suggestions that, at 88-years old, he shouldn't be so attached to them. It took us a year to find a dentist who prioritized his overall health, with the least invasive options, and who worked with us on fees. While we searched, my father's health and quality of life suffered; but he remained steadfast that he deserved better care, and he was right.
19
My 91 year old father in law and 81 year old Mother in law both removed their teeth for dentures in the last few months. It took longer to heal and they struggle with ill fitting dentures and meal times which is their most social times of day are now difficult, painful, joyless and dreaded events. Every time they need an adjustment they travel 75 miles to find the dentist they trust and the one that will be most sympathetic. We tried providers closer to home and that was a failure with the provider taking their money and telling them there is nothing more he can do, Basically abandoning them. It is hard to find care for the elderly that is convenient, affordable, compassionate and specific for their age and other medical conditions.
18
You’re not terribly far from Boston. A possible alternative for your in laws may be Boston University Dental School’s clinic. It may be students doing the work, but they are managed and closely supervised by outstanding dental practitioners.
3
Very unfortunate situation. But to ask taxpayers to fund a good cause but one not necessary, is not fair. The ROI is not there.
2
Tufts University Dental Clinic has operated for decades, as well as Boston University's. Call them.
2
Be patient. The dental field is going to be heavily impacted by automation and robotics, just like many others, with the result being much cheaper dental care in the future. For example:
-------
Chinese robot dentist is first to fit implants in patient’s mouth without any human involvement
Thursday, 21 September, 2017
http://www.scmp.com/news/china/article/2112197/chinese-robot-dentist-fir...
--------
Also much progress is being made in the labs on regrowing human teeth.
And it has been discovered that an Alzheimer drug applied to mice teeth can completely regrow the tooth enamel and eradicate cavities. See:
https://www.nature.com/articles/srep39654
6
"Adding a dental benefit to Medicare is popular. "
Actually, I'm pretty sure all benefits are popular. Paying for them, not quite so.
20
We can all use the "extra money" that Trump and company "gave us" in the Tax Cut and Reform bill. Just typing that made my morning coffee taste bad.
10
Bernie Sanders brought this disgraceful situation before the public in his campaign. Something should be done as free dental clinics, and/or reduced dental care through universities with dental programs are almost non-existent (and some are very costly). Perhaps Democrats could incorporate dental care into their presidential platform next election. Alas, we are not all rich.
13
It can also be very difficult to get dental care through dental school clinic as there are huge numbers of people trying to get care.
11
We should not be reduced to having to rely on dental care by students!
3
Not to mention painful. When you are in the care of students, they aren't yet at the skill level you may be used to.
Your time in the chair will be long, you may be poked with tools, and you may end up with ridges in your enamel where the student was overzealous with the scraper.
And you will likely be surprised when at the end of that 3 hours worth of pain, that you will have to reschedule to do THE REST. (Yes, after sweating bullets for 3 hours in the chair, they were only half done.)
1
Welcome to the latest discovery in America about health care. It includes the mouth. It should include the eyes, the ears, and every other part of the body. And it should pay enough to the dentists and other participants so that patients are not forced to go find new caregivers every year or so.
The way America handles health care in general is a disgrace. Just like you get the best justice money can buy you get the the best medical care money can buy. Not enough money, not enough care. And we can thank both parties for this state of affairs.
49
There are dental insurance plans for Medicare recipients, but they are paltry and have delays in treatment and low maximum annual benefit limits (one plan is $600 in annual premiums for $1,000 in annual benefits.) Add the supplement, have the cost be $10 - $15/month, subsidized for those on SSI, and no tax increase would be necessary. The dentists would participate en masse, as they do in Medicare. They don't in those limited plans, making it not just expensive, but hard to find providers. Of all our healthcare problems, this one is so easily solved.
11
From the time when my husband and I did a cost/benefit analysis of the dental insurance offered by his employer to date, dental insurance has seemed to be a joke. Instead of providing catastrophic care coverage, it pays relatively piddling amounts, making self insurance a no brainer.
7
For a few years, I enrolled my wife and myself in the AARP Delta Dental Insurance program. After two years, (yep, it took me that long), I realized I was actually paying more for the premiums and actual costs than if we would just pay cash. Citizen60 is absolutely correct.
6
These Medicare Advantage Plans are not available to people under 65 - people who are on Medicare Disability and who might actually be somewhat work able if their medical needs were addressed comprehensively.
4
Dental insurance like all insurance is based on who takes it. If you like your dentist you should keep your dentist. My dentist had taken my insurance for years, but he quit taking all insurance and he bills at a higher rate than the insurance was paying. Since he was a great dentist I stayed with him and dumped the insurance. Some of my friends have found great dentists in Mexico. These Mexican dentists graduated from great American universities. If my dentist were no longer available, I would drive a couple of hours to Mexico. My cleanings are done by very capable dental assistants. I have never figured out why some dental insurance hasn't offered Mexican dentistry. It may be not be legal.
5
There is nothing illegal about it. Some health companies have experimented with this in the past. I seem to recall seeing something about this on 60 Minutes in the past.
As for dental, just search 'dental tourism' and you will get millions of hits.
4
Unfortunately driving to Mexico for dental care isn't feasible for those of us living in NY - US healthcare is so primitive -not covering dental hearing & vision, part of the body no?
Esp when bad teeth poor eyesight & hearing loss profoundly affect one's health! All about the $$ once again - shameful!
1
Glad to hear you can pay for your preferred dentist. Most of us can't.
2
Gee, do all the members of Congress (both houses) get Cadillac dental along with Cadillac health insurance FOR THE REST OF THEIR LIVES? Probably. Gee, asking them to change the rules for Medicare and Medicaid is like asking all the blind men touching the elephant to know the big picture. They have no clue and they have no incentive to change these policies b/c they are in the pockets of big-insurance, big-pharma, and the rest of the money power. Dental insurance is capped at a very very low amount that insurance will pay out, and the rest of all care is then out of pocket. Big-insurance, Big-pharma, and 535 senators and reps who are in their pockets. We are doomed!
16
Yes, Congress needs to "eat their own dog food", just as we must do. We need some kind of initiative to lock in laws that will ensure that Congress does not get any special treatment/benefits when it comes to healthcare.
So how do we go about doing this? Any ideas? Maybe we need a bunch of 15-17 yo kids to drive this forward?
12
Yes, not only do members of Congress get dental coverage in addition to medical for the rest of their lives, but I believe just about all retired federal employees have access to it.
5
There is near-zero sentiment for increasing Medicare taxes to pay for more benefits, thereby transferring even more resources from current workers to retirees. Indeed, we are constantly told that boomer retirees are on the whole better off financially than the millenials who are supporting them. So if seniors are to pay, can it be any cheaper to pay for dental care through insurance schemes than through direct billing? I don't see how. You still have to pay for all the dentists and their facilities, but in addition, now you have to pay for all the bureaucracy and paperwork involved with insurance. Plus you have the overutilization and lack of cost control that is associated with a having third-party payer. Yes, there will be many who genuinely can't afford dental care, and they need to be helped, perhaps through free clinics. But middle-class folks need to take some responsibility and make room in their budgets for dental care.
5
There is ALWAYS near ZERO incentive by Congress to spend additional monies on anything out side the military-industrial complex.
Given that we spend more on our military than the next 8 countries or so combined(!), what if we cut the defense budget by 50% and directed that money to better healthcare for USA citizens?
Sounds like a plan to me!
18
Personally, I think that if Congress can come up with the tax breaks it just gave corporations and millionaires, it can come up with another break for people saddled with both medical and dental expenses that are not covered by insurance -- what I have in mind is a tax credit for all medical/dental costs paid out of pocket that exceed 5% of adjusted gross income.
Personally, I think this is a more realistic goal than dental insurance that would cover little and be accepted by few dentists.
13
YES!!! Cutting military budget is like cutting teeth. Pun intended~
Dentists don't accept Medicare because doing so would mean a) they would have to accept what Medicare pays plus a modest copay from the patient; b) they can not balance bill; c) if they accept even a single Medicare patient they have to accept all. These are the rules that physicians are required to follow and the dentists want no part of it.
6
Can you blame them? MD's should never of made this deal with the devil.
2
This is why many MDs where I live are dropping Medicare patients. Not worth the trouble.
1
The AMA, acting as the guild that it is, vigorously opposed Medicare until the government let Drs and hospitals charge "reasonable and customary" fees. These gave way to price fixing by the government in the 1980s once it realized that the system would go bankrupt if it stuck to the original agreement. Drs and hospitals are legally and economically trapped in this paradigm, while dentists, to their prescient good fortune, have not and never will.
1
Yes, Austin Frakt is correct that lack of dental care and failure to treat gum disease are big holes in our Medicare system and wind up costing the government more because untreated infections cause more serious conditions—like heart attacks and strokes. “Making a case for this in the political arena would not be easy, though,” Frakt argues. Yet the case has been made in the New York Health Act which has passed the State Assembly overwhelmingly in the past and is short one vote in the State Senate. Up for reconsideration this year, the legislation ( A 4738 and S 4840 ) includes dental care (among other benefits like reproductive health, vision, hearing, prescription drugs, lab tests and medical supplies) in addition to primary. preventive, specialists, hospitals and mental health at a net savings of 45 billion dollars. Paid for by a progressive payroll tax and income from dividends and interest, the plan would be cheaper for 98% of New Yorkers than the current insurance based system. And it would eliminate the potential gravity of cavities. One wonders why the New York Times fails to report on a plan that has been vetted as cost effective by healthcare experts.
17
Overall health begins in the mouth!
Medicare should cover dental health.
Medicare would save money on other more costly procedures if all senior citizens had no gum disease and tooth decay.
9
I think I can speak intelligently on this subject. I care for my teeth excellently. Since I aged into Medicare 2 years ago, I've now experienced the realities of the dentists who will accept Medicare and it's not a pretty picture.
Two dentists have now attempted to scare, or scam me into unnecessary dental work. It's bald-faced and despicable. These dentists don't feel they're getting paid enough for their services from Medicare and my response to them is this: why are you accepting patients with Medicare if you feel you're not getting paid enough?
Don't look to your patients to make up for your erroneously perceived monetary shortfall. Stop attempting to scare or scam your patients into paying you an obscene amount of money for things that are already covered under Medicare.
A case in point: at my last dental appointment, my dentist told me I needed a new crown that would cost me $350 dollars and he "preferred" this crown over anything Medicare allowed. If I chose the crown Medicare allowed, I would pay less than $100 and it would do a perfectly wonderful job of filling the need. Are you getting the picture here?
This is clearly an abuse of power and taking advantage of an older person, and seeing them as a money pit. No one promised dentists a lavish lifestyle. No one.
It's up to us to change this.
8
He was giving you a deal a 350.00.
Fix your own teeth if you don't want to pay for a service. This is a business not a charity. The dentist doesn't love you.
9
If you lived in NYC that quote would easily have been $1500-$2000. Also, the fact that you have "Medicare" that covers dental care is pretty good in itself, as mine doesn't and never has.
4
Such vitriol doesn't do you or your comment justice.
Obviously, I know what a crown costs. I get it. But, I've now earned the right to expect what I've paid into the system to be there for me as I age.
I, more than likely, paid for your mother, father, aunts and uncles to receive their Medicare and Social Security benefits. I've earned the right to expect fairness and honesty and for my hard work to be rewarded with my own benefits.
If you have a problem with that, that's on you. I will never apologize for earning these benefits.
6
I have had the misfortune of needing to have dentures made while covered by Medicaid. I am a 63 year old woman receiving Social Security Disability Insurance, living in Colorado. The outrage I encountered was that it seems built into the system that if you need Medicaid to pay for your dentures you MUST go from 2 to 6 months without any teeth after they pull your natural remaining teeth, before they will give you your denture. I was unwilling to go into the world beyond my front door without any teeth, and tried to curcumvent this requirement for months with no success. I came to the conclusion that the reason Medicaid makes this a requirement, one that people with other insurance avoid because they are given an immediate, or temporary denture to wear as their gums heal, is because our government feels that people needing financial assistance should pay their share through public shame. How outrageous that low income people don't get a temporary set covered and must go toothless for quite sometime before they can sport their dentures. Poor shaming of the worst kind. Not to mention that ones dentures will never be adjusted to after so long without one. Why was the program set up this way, and why has it been allowed to proceed this way without a change for so long?
18
This really doesn't have to be.
Because of disease I had all of my teeth on the top removed when I was 16. All the fitting took place weeks before the removals and on the appointed day the teeth were removed and the permanent denture device was put in. As my gums shrunk the plate was adjusted. I never had to go without teeth.
Right now my upper denture is very loose. After 50 years I don't have enough bone to support them and relining them won't help. I either need a whole new plate made or some implants to anchor a new plate. I have the same problem on the bottom.
The costs are very high, more than I can afford. Dental care has become very expensive and a lot of it is going to pay for high tech processes when older methods would suffice. My mother in law was going to a dental practice that kept her coming back week after week. I thought it an excessive amount of work and expense for an 88 year old woman who refuses to eat properly. I think they were making a good living off of her.
7
SHelley: I don't know where you are having this work done, but if you are going to a place like a dental school clinic this may be standard operating procedure for them. I tried to cut down on some of my enormous dental expenses by using the clinic at a university dental school and encountered that kind of delay and frustration.
5
Dental care is important. Vision care is important. Hearing care is important. All three can be very accurate predictors of undiagnosed medical problems. They can also be early indicators of exacerbation of existing illnesses. About five years also go there was a study about dementia, Alzheimer's, and their direct relationship to periodontal disease prior to any noticeable symptoms of the conditions.
There is no reason that MC cannot set a five year plan to bring these missing parts of overall health care into their normal coverage. As of today, those earning income pay 1.45% of their earnings into MC as a premium. The employer matches that 1.45% for a total of 2.9% paid over for all earnings. The first step is to increase the employee contribution to 2% and incrementally increase that to 3.5% over five years. At the same time increase the employer's share to 2.5%. Then in five years begin phasing in dental, vision, and hearing benefits.
The other issue that most do not consider is that MC recipients have paid into MC their entire working lives. Then once eligible for MC they pay $134 per month for coverage. Part A covers hospitalizations at 100%. Part B covers office visits and labs at 80%, the beneficiary pays the other 20% as a copay.
The premium increase for the missing three coverages would need to factor in the average Social Security Annuity of $1400 per month. It would be too much of a burden for the total premium to exceed more than 10% - 15% of that miserly sum.
5
WIllWho: Something else that needs to be addressed in Medicare is the skyrocketing number of people qualifying for SS disability benefits, which also makes them eligible for Medicare, often long before they otherwise would be. I have heard actuaries say that one of the prime sources of underfunding in Social Security is the contributions required for the disability part of the program (as opposed the the contributions we pay for the retirement part). I believe I even read something by one who said basically all of Social Security's "underfunding"problems would be resolved by simply adjusting disability contributions to reflect this new reality. I assume adjustments should also be made to Medicare cotnributions to account for this.
8
You can thank the American Dental Association (ADA) for this. They lobbied to have dental excluded from Medicare.
Dentists have a monopoly that must be broken up. Dental Therapists need just two years training to do simple dentistry as well or better than dentists and will go into mouths and areas where dentists refuse to go and charge lesser fees.
Of course, organized dentistry, with its pockets full of corporate cash, lobby long and hard against legalizing Dental Therapist choosing to protect its lucrative monopoly instead of Americans' dental health.
Dentists prefer to treat the water of low income people rather than their teeth. Dentists love fluoridation mandates so maybe we need to mandate that they treat a percentage of people on Medicare for a lower fee
13
Why don't you become a dentist and treat people for the fee you think is reasonable. Mandate yourself.
6
What else should I be to fix ills of the society? Doctor? Surgeon? Drug makers? maybe, it will be easier to have a system that would encourage more reasonable fees. I've heard such places do exist in Europe. We don't even need to invent the bicycle again.
1
I agree with the article but there are some relatively cheap dental plans available that will get you two cleanings, x-ray and exams a year plus lower costs for repairs. A crown would cost me about $800. Implants are not covered. A single surface repair of a tooth is about $55 if I remember correctly. There are no annual limits either, unlike many other plans!
For example, I pay $11 and change monthly to a company called Premier Access (part of Guardian Insurance company), which gets me what I described above. Unfortunately with plans like this, dentist availability is low and they tend to get lower ratings on Yelp.
My Blue Shield supplement Medicare plan "N" also offers more standard dental insurance with the usual $1000 or $1500 annual limits and more dentist availability. Costs start at $35/month.
It's criminal how raw Medicare doesn't cover dental or eyes (except for glaucoma, AMD and cataracts, I think). And even what they do cover often comes with exclusions. For example if you have foot problems and need orthotics you are on your own - UNLESS you happen to be diabetic! Huh?
I guess the dental and eye MD lobby's kicked in enough cash to get excluded from Medicare coverage by Congress.
10
" Unfortunately with plans like this, dentist availability is low and they tend to get lower ratings on Yelp."
Ain't that the truth! And just try finding any dentist in a place like Manhattan that accepts ANY of these el cheapo plans, including the ones groups like AARP like to tout and including the ones offered through Medicare "Advantage" plans!
I can only assume any "dental" coverage offered through Medicare would be just as limited and low quality.
I would be happy to get a tax credit for the dental work I'm having to pay for out of pocket. As it is, I'm having to take huge amounts of money out of my IRAs and 401(k) way before I wanted to or before any financial planner would consider wise -- with the result that I am not only (1) incurring a huge increase in annual income taxes but also (2) seriously jeopardizing my ability to continue living independently in retirement,
11
Health care in America is a big scam. We are definitely becoming a 3rd world country.
32
The Medicare program covers a dental screening. What good is finding out you have serious dental issues but can't afford to do anything about it ? Extremely frustrating and discouraging to say the least. As a nurse, I'm well aware of the issues surrounding gum disease and the effects it can have on overall health. The majority of those I know on Medicare, including myself, can't afford to travel outside the US for affordable dental care. America's health care system is broken. Sadly it's not likely to be fixed anytime soon.
29
I wondered why the government doesn't consider the mouth to be part of the human body. The cost of dental care has to be part of Medicare coverage. It's just dumb not to have that coverage. Our politicians need to be educated in human anatomy.
62
Neither did corporations or other businesses consider offering dental coverage (insurance) until the 1970s, and the health insurance that One did have in the 60s and most of the 70s did not include dental-health care. It's not just 'the government' -- ALL who offer insurance for health ought to include dental health in their health insurance plan. But today, no one does. There's health, dental and vision insurances -- 3 separate insurances, and now hearing and vision medical problems are covered by health insurances.
"Greatest country on earth"
If it were only so.
15
Many of us are Medicare Supplemental plans so even if a Medicare Advantage plan covers dental, it doesn't apply to us.
I believe that the Washington Health Care Exchange offers dental plans for those who are interested.
4
You aren't missing much. As I understand it, the dental benefits under those plans are very limitied and practically no decent dentists participate. I assume the situation would be similar if Medicare were to offer a dental "benefit."
3
I have Blue Shield Calif. through a Plan N supplement. They have decent dental plans with good dentist selection but the monthly cost starts at $35.
When you choose a Medicare supplement plan, their are usually many providers to choose from. You need to look at not only what they are charging but also what benefits they offer in addition to mandatory required ones.
Same with the Part D drug plans.
Medicare and all the options are horrendously complicated and really need to be simplified.
3
Joseph, as I learned from helping my mom shop for a Medicare Advantage plan in her home state of Idaho while using a California IP address which automatically returned 'local' results...
California has a lot more to choose from than many other places. Maybe it's because the population base supports more insurance choices, maybe it's because of the liberal nature of the state's laws...
Make no mistake, the availability you have in Cali is not representative of the experience of most people on Medicare in this country.
1
The high cost of dental work in the US is a factor of many reasons, some notably mentioned in this article - high cost of education, high relative cost of running a practice (rent, labor, etc), cost for insurance to mention just a few.
In my opinion the way forward for the US to provide more affordable services in this arena may rest with breaking up of the strangle hold that the American Dental Association (ADA) has on the field. Rather than an "association", I believe it may better be termed a "guild". A guild that has perfected the art of lobbying in our state and federal legislatures.
I invite anyone reading this to google a copy of the ADA's Code of Ethics. There you will find a few pages actually devoted to the subject of ethics as its title suggests. However, you will find more of its paragraphs devoted to admonitions against any one dentist with the temerity to actually openly compete against his fellow members on quality or price. To do so will result in professional freeze-out of the erring practitioner.
This is one of the major reasons that the majority of our fellow Americans are priced out dental care.
17
It would be a blessing if state laws allowed paraprofessional dental hygienists to operate their own businesses (nominally still under supervision of dental doctors but more easily licensed by states, especially interstate license transfers). They could perform routine dental exams and cleaning, even simple brushing of silver diamine flouride to treat cheaply no-drill cavities. Then they could refer more complicated cases to doctors of dentistry. The present system is only to make money for dentists who favor expensive and cosmetic procedures rather than cheap routine care for dental health. Even if hygienists were not allowed to bill Medicaid or Medicare, such independent practices could be cheap enough for poor patients to afford, and would vastly improve dental health.
33
private dental coverage is expensive (unless subsidized by an employer as a benefit...which of course translates into less pay). if covered under medicare the cost would be an unwelcome burden on medicare users, unless subsidized by federal funds...translate, higher taxes. everything has a price, nothing is free, the real chore is deciding what the cost/benefit equation is...and not everyone will like the answers.
3
Not to mention the fact that if covered under Medicare it would probably be just as unsatisfactory as the skimpy coverage currently available to individual purchasers of private plans.
I would like to see changes in our tax laws that would allow a tax credit for dental/medical out of pocket expenses above a certain amount (say 5% of income).
1
Kaiser offers a dental add-on (among other benefits) for the Advantage plan, but the pool of dentists available is limited to storefront clinics and the like. Not necessarily poor care, but certainly not the best. A plan more like Medicare would be a real improvement.
4
You can be sure that if Medicare were to add a dental benefit the pool of participating dentists would be just as limited as what you see you with the Kaiser Advantage plan. As it is, where I live, many doctors now refuse Medicare patients. Why should dentists take them?
4
There are an awful lot of dentists. In my area, the density of dentists seem to be on par with nail salons and hair stylists!
That means that they may have to take plans that don't pay as much because they need to pay the bills in a competitive environment.
1
Medicare is going broke--who is going to pay for dentists when no one wants to pay for MD's? Forget it.
Take care of your teeth the best you can and live with the consequences.
5
a narrow minded way of looking at health care. I guess you think your mouth isn't part of your body.
17
Who told you Medicare is going broke?
Either way, sure provide all the Medical care ya want, but poh hey ya got a bad heart valve because we can't dare cover teeth. Seems penny wise pound foolish.
8
And what if you had a disease that caused you to lose all but 7 teeth? The consequences are not being able to eat properly. Or poorly fitting dentures because after 50 years you don't have enough bone to support them and you can't eat because of the pain?
4
As my grandmother used to say "penny wise and pound foolish". We continue to see this everywhere but most significantly in health related matters.
22
Hear hear! It's time to address this problem, not only with Medicare, but the entire system. I've recently realized that my primary care doc has no idea that I have chronic periodontal disease. Not a good thing.
25
Why don't you tell your primary that you have chronic periodontal disease?
1
This is a great article and I'd love to share it with others, but for some reason I can't email it. I can share it on Facebook, Twitter, etc. But I don't want to do that. I want to EMAIL it. Why am I paying for this subscription if I can't email it?
2
I think there's an option to copy the link, which you can paste into the body of an email. The mobile link is:
https://mobile.nytimes.com/2018/03/19/upshot/medicare-missing-dental-cov...
4
cut and paste the link
4
It’s true: it makes no sense. Same with eyeglasses and hearing aids.
46
Here's how it makes sense: There is LIMIT to what the rest of us can provide for old people.
I realize that they paid in all that was required of them, but people are living longer now and what was paid in is not enough.
Those lucky enough to get benefits at 65 need to be grateful they get anything; the rest of us won't despite the fact that we are paying into the system, too.
It's flat-out greedy to keep demanding things.
6
Honebee: Do you also prefer the tax breaks this administration has given to corporations and Wall Street over the possibility of giving a tax break (a larger deduction or even a tax credit) to people who pay out of pocket medical/dental expenses about a certain percentage of their income? Perhaps you would find that giving an unfair advantage to people with the bad luck to have a medical or dental problem and weren't at the same time smart enough to make a million a year on Wall St?
First, low income seniors are NOT living longer. In fact, life expectency is declining for this group. Besides US SS benefits are the fourth lowest relative benefits of their kind in the world, and almost every advanced country has a system similar to SS, with most countries having lower retirement ages and more frequent benefit increases, so their already more generous benefits keep up with inflation. http://www.businessinsider.com/almost-every-other-advanced-country-has-h... And life expectancy is higher in many of these countries than it is in the US.
3
A long time ago even the most remote school provided periodically dental care by bus.
Nowadays health care a product of luxury,reflecting income differences.
A loss of social health care,neglecting health as one of the Human Rights...
10
I'm not sure that was true across the board in the US, but I would definitely support spending more money now to educate young people on the importance of doing everything they can to adopt habits that will help prevent dental problems in the future.
Part of the reason (maybe most of the reason), I am convinced, for the dental woes I am experiencing in late life is the substandard care and education I received in early life.
3
May I add another constituency to the uninsured, untreated population--Military Veterans. Dental care at the VA is provided only for 100% disabled Veterans--the great majority of Veterans have to get private dental insurance or, for the thousands of unemployed or low-income or Medicare -age Vets, pay out of pocket or do without. In my 5 years as a VA mental health doc, I saw dozens of Vets who suffered terribly with dental disease and were sent down the road to try to be seen at a University Dental School clinic or, in more than one case, pull their own abscessed, rotting teeth with a pair of pliers...
55
Medicaid is the same -- no dental. I need complete restoration and my dentist gave me an estimate: $12,000!
14
In New York state I believe dental is covered for adults (it varies from state to state)
By the way, $12,000 for complete restoration is very low by New York standards. Depends on exactly what you need, but imagine it would be at least 3 times as much here.
8
Medicaid might cover dental care in NY, but good luck finding a dentist who accepts it.
I tried new dentist advertising implants. $50,000!
I told him I'd be back after I hit one of the lotteries.
2
My wife’s medical & dental coverage as a long time employee of a huge corporation had both decreased coverage and increased monthly premium over the past 10 years. The ACA helped restore some of the coverage, and even expanded it some.
The one glaring omission of her company policy - underwritten among 200,000 employees - was its odd inability to do more than absorb half of the truly expensive dental procedures.
“Free” yearly exams and cleaning (as policy perks) meant little when the deductibles resulted in many thousands in out of pocket dental payments.
Further, it became suspicious to us that there was never an exam that did not produce grim faced admonishment from the dentists regarding hugely expensive procedures that we just “had to have done”. And that failure to accomplish those procedures - ranging to five figures - would result in our demise.
If dental work is really that important - and I agree that it is - why on earth is it not better covered through insurance? Whether private or Medicare?
If this was vehicle insurance, how many Americans could afford to drive cars, given that any accident or even nature caused damage required a 4 or 5 thousand dollar co-pay?
47
I think there is not much agreement on what dental care is "necessary" and that is why there is so little coverage for things like crowns and implants.
3
My dentist mentioned one time that he could really "brighten up my smile by capping all my front teeth". It was easy for me to say the word no. Take care of my teeth. I have never heard the suggestion again from him.
1
"Ms. Willink’s study estimated that a Medicare dental benefit that covered three-quarters of the cost of care would increase Medicare premiums by $7 per month,"
Where on earth did this woman get her numbers? Every group dental plan I have ever had cost a lot more than than that AND had a cap on payouts of $1500--$2500 per year. And we've been in some very large group plans.
9
Right... but the cost of your group dental plan was expensive in part because it included a healthy profit for the insurance company; its premium wasn't designed to merely cover the cost of your dental care.
47
I have had dental checkups twice a year since I was a child. We didn’t have fluoride added to the water so all five of us kids ended up with some cavities that were filled.
As I hit my fifties I needed crowns and a bridge and could afford them as I was working and had good dental insurance.
BTW coverage by most dental insurance has NOT risen in 20 years despite moving into an era of dental implants which can cost $1500 to $2500 each!
Periodontal (gum) disease becomes more prevalent as we lose bone tissue and have retraction of gum tissue. If a filling cracked and fell out I used to get crowns but there isn’t enough of the tooth left to provide a base for a crown so it’s extracted.
I became disabled after a severe beating/mugging, could no longer work. I had to move from my own dentist when I moved out of state to a rural area and finding another good dentist nearly became impossible...besides I was dealing with breast cancer...the multiple surgeries radiation and chemo on my own as I became a widow in 2009.
A month ago I went in for a tooth ache. Told it was a cavity and was filled.
Turned out to be a large abscess and I was ill.
I got a $20k estimate to care for abscess and periodontal treatment! Another dentist just ended pulling all teeth lower right jaw incl a front tooth
I am So embarrassed as I don’t have money for implants
The biggest difference between the wealthy and the rest of us are our teeth!
Experts say Trump has had $30k of work!
The “gap” widens
98
Well $30,000 doesn't buy much dental work in Manhattan, so I wonder where Trump had is work done.
14
May God bless you!
1
Trump has had 60 k of dental treatment every 10 years because all dental treatment has to be replaced .
1
Recently I filled out the Medicare health questionnaire, which was described as a tool to help me.
But I noted the lack of any questions pertaining to dental care, a key factor in my health, as noted in the article.
But that's because the questionnaire is actually a tool to help my insurance company obtain risk adjustment subsidies from Medicare based on any existing health conditions I have.
I spent more than $10,000 last year out of pocket for dental care, basically restoring old, failing dental work, the same issue most people of Medicare age seem to have.
Private dental insurance makes no sense. Medicare dental coverage that includes restorations at extra cost could make sense if accompanied by negotiated price discounts, as with the medical side of Medicare.
Dentists would lose some profit margin but would keep more business that is otherwise going to go eventually to dental holidays in other countries, including Europe and places with really nice beaches and far lower dentistry costs.
37
Or just don't bother to have work done anymore.
2
There’s also the mounting data that the healthcare industry could benefit from covering dental as part of medical. Consider those 800,000 ER visits per year for dental-related problems. Wouldn’t more people get the preventative dental care if it were covered by their medical insurance? Couldn’t medical insurance companies ultimately save oodles of money on emergency care if the problem were nipped in the bud free of charge? This is true for every age group.
Medicaid does not provide adequate reimbursement rates for dental care. Medicare should note this and realize that good preventive care would lower what they ultimately pay in Medicare medical outcomes when a cardiologist bills pile in.
25
Not hearing or vision either - at an age when most needed. Comprehensive care is what is needed.
97
Thanks for shining a light on this growing health concern. We can only hope that one day Americans have greater choice in dental options, particularly for expensive reconstructive work so commonly needed by Medicare and Medicaid patients. Meanwhile dental travel remains an option, which is why some 600,000 US patients cross borders every year for dental care.
4
Did these same now-older citizens campaign or vote for additional coverage when they were working hard in the '50s and 60s? Dental coverage was only offered as a company benefit in the '70s. Any addition to the cost of Medicare is politically untenable if you haven't been paying attention to the news lately.
This article misses many important pieces of this issue. It brushes off financing as hardly worth thinking about, which is absurd. The Seniors (and disabled) need an immense amount of dental work. There should have been an estimate of how much. There should have been an estimate of how much Medicare would have to pay to cover that work, even assuming the manpower to do it could be found. But of course that manpower is not there now. There should have been an estimate of how many more people we would need to do that work, and some account of how we were going to get to that number. A decent article on this critical topic has yet to even hinted at, let alone done.
7
The only ones on public coverage (Medicare,Medicaid, VA, ACA) who always get dental coverage are kids on Medicaid
Medicare Advantage offering dental? Puh-Lease....
Advantage Plans in this state cover 2 cleanings per year and xrays every 2 years. That is it. No fillings, no crowns, no bridges, no root canals....... And the additional premiums to get that de minimis coverage are as much as the cleanings costs.
Medicare Advantage plans are terrible. They have fixed dollar copays that 130 -300% MORE than the 20% copays of original Medicare. For example $45 -50 per physical therapy session is charged by Advantage plans vs $19 as the 20% copay of Original Medicare B
NYT's beloved ACA is no better. No dental coverage for adults buy, hey, unlimited urine testing for drugs addicts at the cost of over $250000 in 3 months (per the NYT article on that)
13
In some states -- New York for example -- adults on Medicaid DO get dental care, and often very comprehensive care.
1
Medicare Advantage plans vary by state. I live in Indiana, and have had wonderful experience with the two MA plans I've had, including their dental coverage. I do think they perhaps work better for beneficiaries in metropolitan areas, because of the very large provider networks available in metro areas.
2
I live in NY state - in Woodstock
where are these dentists you mention giving comprehensive care for those on Medicaid? I must pay out of pocket but he gives me somewhat of a deal b/c he is "somewhat" compassionate. I have bartered also. His practice is called "TransenDental"- but rather than go through the trauma I avoid/postpone any dental appointment. My advice:
Bottom (& Top) line- take REALLY good care of your teeth & you won't need to go to a dentist -
Oil pulling, flossing, vegetables & greens- no sugar (starches) hard candy, nuts or dairy (mucus attracts bacteria), etc.
Eat healthy, proper oral hygiene- take care of yourself & your teeth will take care of themselves- & last a lifetime-
Wouldn't this be a wonderful place to introduce some of that free trade and market forces that the overclass are always on about? Mexican dentists might like to open clinics in the USA but I'm guessing that isn't covered by anything in NAFTA.
17
There is a growing evidence that preventive dentistry is a good investment and should be covered by Medicare and medical health insurance plans. Far too often people put off their dental check ups and cleanings for financial reasons. This has the effect of allowing small easy to fix problems to become larger and more costly to remedy.
For more information please visit:
https://lspindelnycdds.blogspot.com/2016/03/but-i-cant-afford-x-rays.htm...
8
Maybe when you're younger preventive dentistry pays off; but by the time you're eligible for Medicare it's often a lot more than preventive dentistry that you need.
11
ellienyc: I gather you did not get good preventive care and THAT IS WHY you now must spend thousands per year!!!
You pay when young for preventive care or pay when old for extensive repairs, implants, dentures.
Teeth wear out. My dentist says they were basically designed to last 50 years, which was the human life expectancy for most of history. Teeth were not designed to last 90 years.
The popular descriptions of Medicare and Medicaid typically praise them as some kind of model separate from the rest of the US health care and insurance system—ignorant of the rationing and gaps in coverage. Access alone to a “basic” level of health care does not make it universal or stellar. Vision, dental and hearing care are not part of health care, especially as you age? Welcome to America’s idea of a free-market health industry, which is big business-first, consumers last.
42
We are often told we should have "Canadian single payer" type of insurance. The Canadians do not cover prescriptions....dental or vision...in their national plan. If you want those things, you must pay for separate insurance policies.
Not quite accurate. It depends which province you're talking about. There is a national standard and provinces must meet that and then cover more with or without cost-sharing as they choose.
.
I'm one of those senior who's unable to follow through on dental care. Yes, Medicare program pays for 2 cleanings a year. Period. I have lost one tooth and have 7 teeth that have cavaties beneath crowns, which means both fillings and new crowns. The cost is as much as my annual social security payments--and no free dental clinics in my area. I do worry about how this affecting my health.
13
I don't know your age, but you need to be practical here. Those teeth are a lost cause. Have them pulled and get dentures or implants. They are expensive but not "a year's worth of income".
I looked into the dental coverage offered as an add-on to my Medicare advantage plan. It pays for two exams and cleanings per year, but when it comes to paying for the work I need done (estimated at $4000), the plan would have paid for only $1000 of it--at a premium of $60 a month, which would mean paying most of the deductible myself.
I see a trip to Mexico in my future.
7
My own dentist does not feel dental insurance is that good a value -- the premiums are about equal to the actual cost of two cleanings plus one set of xrays per year anyhow. It's a wash. (The dentist discounts for cash payments.)
So the "coverage" is mostly for procedures, and they only pay 55% for in-network at best, PLUS a deductible of $75 per person and the entire coverage is capped at $2000 a year. That's OK if you have a rare crown once every decade, but if you have seriously rotten teeth....it won't cover a fraction of your expenses.
I've looked into it, and there IS NO dental insurance you can buy, at any price, that covers you at 100% for anything you want done. It just does not exist.
"In 2006, a prescription drug benefit was added to the program."
And the prices of drugs soared - what a strange coincidence! As long as people had to pay out of pocket, drug makers were forced to moderate their prices, or they wouldn't make any sales. Once they had the insurance company on the hook, there was no limit to what they could charge.
Are dentists in business to make money? Would they charge more if they could? Stand by for the answer....
7
Drug prices were rising rapidly before 2006--that's one reason that the Medicare drug plan was passed by a Republican congress and president. What they left out was the ability for Medicare to bargain for lower prices. These plans pay straight retail, the highest prices possible.
3
"Many people view Medicare as the gold standard of United States health coverage, and any attempt to cut it incurs the wrath of older Americans, a politically powerful group."
Well I don't know what kind of health coverage these people had before they went on Medicare, but if it was like my employer coverage, it was a lot better than Medicare. There are huge gaps in Medicare and a shortage of good doctors (at least in my area) that are willing take Medicare. Further, in my somewhat limited experience, Medicare (and I am talking original Medicare w/Medicare supplement) limits benefits to the minimal ones required to get an 85 year old back to the nursing home, not those required to get an active 65 or 70 year old back to his or her normal lifestyle. So you can end up paying a lot out of pocket.
I also had a good dental plan when in corporate world and have not enjoyed paying $10,000 - $15,000 a year for dental care the past few years. One thing Congress could do to address this problem would be to make out of pocket dental more full deductible for income tax purposes or give us a tax credit for at least part of it.
As much as I miss my corporate dental care, I think it is important to note those benefits are often limited, especially when it comes to newer technologies like implants.
13
As a self-employed person, I find Medicare plus Medicare Advantage to be the best insurance coverage I have had in the past 15 years.
Most of us never enjoyed that Cadillac corporate health coverage.
The best medical coverage I ever had was as a graduate student at an Ivy League university that provided complete medical care, including hospitalization and surgery if necessary, (no dental, though) to its students, faculty, and staff at no extra charge--sort of a miniature version of Britain's NHS.
9
The best medical care I ever had was when I was in the Navy. No premiums, no co-pays and it did anything I needed done. Eye glasses, dental, physicals and if they couldn't fix something and it affected my ability to serve I was discharged with a disability check every month.
The article made an omission. Medicare also covers disabled people under 65. One in three people who get Medicare are disabled, not senior citizens.
4
And some actuaries attribute Social Security's funding woes to the skyrocketing number of people qualifying for Social Security disability benefits, some suggesting that just increasing the amounts we contribute to the disability part of the program (as opposed to the retirement part) would resolve SS funding issues. I assume there aso need to be Medicare adjustments to cover them.
1
Wow! Thank you for printing this story! We almost NEVER hear about the travesty of separating the gums and teeth from the rest of the body when dealing with overall health. And, the audacity to suggest we might deem dental coverage essential to seniors' health- well - how dare you!!!! [ovbious sarcasm]
40
The most important feature of the improved "Medicare for All", HR 676 bill now filed in Congress, is the removal of all financial barriers to dental & medical care. HR 676, single payer health insurance program plan, would save enough on administrative overhead & eliminate huge private insurance company profiteering to provide comprehensive coverage to all the uninsured and upgrade coverage for everyone else, thus requiring no increase in total health spending. It would restore free choice of clinician and hospital to all Americans and give access to every resident of the U.S. All dental & medical bills for covered services would generally be eliminated at the point of service,& full insurance coverage would include outpatient and inpatient medical care as well as rehabilitation, mental health care, long-term care, dental services, and prescription drugs. Medicare for All improves on traditional Medicare’s benefits and expands coverage to all Americans. All premiums, co-pays, deductibles, and co-insurance are eliminated. Support HR 676 ..... 'Everyone in, no one out!'
89
Sounds great!
But what do you think the probability of Congress passing this bill when it would essentially kill the health insurance industry and put many people on the unemployment lines? Unfortunately, close to zero, I'd say.
The healthcare and insurance industries, like the NRA, owns too many Congresspeople.
Teeth lousy from childhood. Root canals w/o anesthesia at thirteen. Parents, dentists and me; all cooperating in the plot to lose my teeth by attrition.
No way to run a life, a family or a nation.
Free health care and education for all are marks of a civilized progressive society.
We are not yet there.
18
I know how you feel. I lost all of my top teeth at 16. Dentures aren't effective anymore because there is no bone left to support them. It's a family thing passing from my mother's side. No matter how many trips to the dentist, flossing, brushing and mouthwashes nothing worked for me and my mother. My siblings don't have it as bad as we do.
For curiosity's sake I went to a dentist advertising implants, $50,000. Instead I paste the denture in and put up with the pain. The four crowns had decay underneath. When one fell out the other three went because they lacked the support. I cut everything with a knife because I can't bite any more. Even fixing it all up with normal practices will cost $30,000.
At a minimum I think we should be providing better education and care for children. I attribute much of my late life dental woes to substandard care and education in early life. I'm sure parents did the best they could, but sure would have helped if the schools could have warned of the rocky road ahead if certain care wasn't taken.
2
The only enrollees in a public plan (Medicare, Medicaid, VA Healthcare, ACA) who always get full dental care covered are KIDS on Medicaid (the ones whose families can not afford to have them in the first place)
The article claims that Medicare Advantage plans (Medicare type coverage sold by private insurers) covers dental.
Well yes if you define 2 cleanings a year and xrays every 2 years as coverage. And the additional premiums to get such coverage are just about equal to or more than the cost of 2 cleanings....
No Medicare Advantage plan in this state plans for fillings, crowns, bridges or root canals -- the big ticket items
(Note: Medicare Advantage has fixed dollar copays that are 30% to 250% more than the 20% copays of Original Medicare B (like $50 copay for physical therapy vs Medicare B 20% copay of $19). Advantage plans are TERRIBLE)
Yeah just try to pay $1500 or a crown or $2500-3000 for a bridge or $5000-7000 implant out of the US median household income of $50K+ ---- let alone out of the median $39,000 that an over-65 couple lives on.
You do without.
29
I completely agree with you and fear any Medicare dental benefits would be as disappointing as those under Medicare Advantage plans. Personally, I would like to see a tax credit or maybe enhanced deduction for medical/dental expenses over certain % of income. Tax credit has the advantage of being available to all, not just those still itemizing.
I have original Medicare w/supplement, but read the info I get each year on Medicare Advantage and am amazed people are willing to pay those huge copays, when just paying regular Part B copay (without supplement kicking in) would be less expensive.
Being on Medicare Advantage is helpful, but when the dentist gave me a projected cost of $4k, I started reading up on Mexico and the prospect of spending some winter months in Yuma, AZ.
8
Just be thankful you don't live in NYC, where the estimate might have been for $40k.
1
An area of GREAT concern is America’s intake of sugar. Not only does sugar causes cavities, we are now finding out that sugar DIRECTLY causes increased triglycerides and lipids such as total cholesterol which then leads to inflammatory changes/plaque inside the arteries that supply the heart, retina, and kidneys.
Simple sugars, such as table sugar and simple carbohydrates such as white rice cause these plaques that obstruct blood flow.
Not only does diabetes lead to heart attacks, strokes, renal failure, (then dialysis and need for kidney transplants.) Just the intake of sugar can lead to obstruction WITHOUT necessarily having the disease diabetes.
Sugars just don’t cause cavities, they can directly cause the above problems.
https://www.sciencedaily.com/releases/2016/01/160113103318.htm
This was known back in the 1960s but the food and especially the beverage industry pushed back,buried these studies. About the same time we started seeing print ads extolling how growing teenagers NEEDED sugar for health!
Most people see that our farms are growing a LOT of corn to make HFCS (high fructose corn syrup) which is found in MANY everyday foods from yogurt,bread, canned sodas, and MUCH more. It will be the #2 ingredient in most processed foods. Read the labels.
All in today’s NYT article “How to stop eating sugar.”
https://www.nytimes.com/guides/smarterliving/how-to-stop-eating-sugar
Not only does sugar take our teeth, it’s killing us.
Bloomberg was right about taxing soda!
9
If you qualify for Medicare based on age and have poor dentition, reducing sugar intake may help your overall health but it's unlikely to do anything for your teeth.
8
not true, reducing sugar greatly improves your health, and also prevents tooth decay & dental problems.
Both are interconnected -
cavities are just waiting to erupt from sugar in the diet...
soda is the worst, also processed food with sugar, white rice, starch from pasta & candy- no amount of brushing can get rid of sugar plaque on teeth. JUST AVOID sugar& practice routine good dental care
It i shocking that in all the debates about health insurance, dental care is never discussed. As poor graduate students nursing our tooth aches 40 years ago, we realized that dental care was a class issue. There are no bargains in dentistry. To this day my car still costs less than the price of replacing my molars due to lack of care and funds. Even my university offered health care that essentially paid for nothing. My Belgian friends must visit the dentist twice a year for check up and cleanings or else they will have to pay for the visit. Shame on America.
43
Though you might also ask your Belgian friends whether their state coverage covers things like implants. Many national health systems cover preventive care (important, especially for children), extractions, probably dentures, but much other stuff not covered at all (though varies by country, and when you do have to pay out of pocket is likely much less than here).
"The initial cost would be an inviting target for politicians who express concern about fiscal prudence..."
"Fiscal prudence" never seems to be a concern for the military budget or tax cuts for the wealthy. But when it comes to healthcare, no, we can't possibly afford that.
77
I would like them to consider the "fiscal prudence" of offering a tax credit to all people whose out of pocket dental/medical expenses are above 5% of income. Or is it our fault for not being wealthy?
5
I agree with your story.
However, due to our de facto criminal health care system, the most expensive by far re our peer countries while measurements of health are some of the lowest among these peer countries and as much as 50 million Americans (pre ACA) do not have coverage, lack of dental coverage is a minor crime.
8
Even dental care at clinics can be expensive. OtOH implants altho expemsive IMO are preferable to dentures which can be very painful and irritate the gum. (Still costs less than out-patient dialysis (I am curious as to how many Americans need this treatment). To what degree is what Medicare costs/pays out correlated to income? assets?? I really don't know.
To what degree is what Medicare costs/pays out correlated to income
Answer: ZERO .
Income has nothing to do with Medicare costs -except that very high income (over $150K for a couple) pay higher premiums
Try paying a $1340 Part A deductible for hospitalization out of the median $23000 income ...not happening
32
Actually, the income required for a single person to be required to pay high Medicare premiums is much lower, around $80k. And if you are a $40K or $50 k person forced to take $30k or $40k out of your IRA to pay $20k or $30k aftertax in dental/medical expenses, you can reach that threshold quite quickly.