Adult Dental Benefit

Today, Medicaid and Medicare dental benefits are often limited, which means adults with lower incomes and older adults get dental care less frequently than they should. And there’s a clear and growing ripple effect from untreated oral disease that can be devastating to overall health.
What can we do to turn the tide?
To increase access to oral health care for those adults, part of the more than 74 million Americans who lack dental coverage, we need to protect and expand adult dental benefits — within both Medicaid and Medicare. 
As of 2020, only 18 states have extensive dental benefits as part of Medicaid. Three states have none at all, while 10 cover it only for emergencies. Medicare, meanwhile, doesn’t have mandated coverage for the treatment of dental disease. It doesn't cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices
Advocates are working hard around the country to ensure adults have these critical benefits. In 2019, at least 14 states implemented legislative or administrative changes to enhance their state’s programs, with positive momentum going into 2020. The work isn’t easy, though, and uncertainty lies ahead because of the ongoing COVID-19 pandemic. Many advocates fear that pandemic-related budget shortfalls could put this progress at risk.

Map of the United States showing Medicaid dental benefits coverage for adults
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How Could Cutting Adult Benefits Hurt States?
A new infographic from the DentaQuest Partnership provides several examples of how cutting Medicaid adult dental benefits could harm job growth and increase costs in states across the country.
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State Advocacy Approaches to Expanding and Protecting Medicaid Adult Dental Benefits
This webinar highlighted strategies, tactics and tools that advocates across the country can use to protect and expand Medicaid adult dental benefits in their state.
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Increased Access Means Lower Costs
Any cuts to adult dental benefits would be shortsighted, as highlighted in a recent infographic from the DentaQuest Partnership for Oral Health Advancement. Simply put, expanding dental coverage can save millions of dollars in preventable health costs.

Reducing preventable dental-related emergency room (ER) visits is just one way. When adults without dental coverage or the ability to afford care delay treatment until issues become severe or painful, their ER visits are significantly more expensive, costing an estimated $2.1 billion per year. What’s more, research indicates that nearly 79% of these visits could have been addressed in a dental office, saving up to $1.7 billion per year.

We also know that oral health is directly related to overall health, and that a lack of preventive care contributes to a higher risk of other chronic health issues. Treating chronic conditions like asthma, heart disease and diabetes, which can all be exacerbated by poor oral health, adds millions more in preventable health care costs to the system. The cost to care for these diseases contributes to growing national health expenditures in the U.S. — above and beyond the $520 million Medicare spends annually on dental emergency room visits.

An Issue of Equity
The lack of an adult dental benefit also adds a tremendous cost burden to the millions of families and individuals who rely on these programs. Research from the DentaQuest Partnership has shown:
  • Those in poverty spend 10 times more as a proportion of their family income on dental services compared to high-income families.
  • 93% of individuals living in poverty have unmet dental needs compared to 58% in high-income families.
  • Nearly 4 in 10 Black and Latino adults reside in the 14 states where Medicaid’s adult dental benefits cover no services or emergency-only care.
The stark reality is that lack of access to oral health care disproportionately impacts those who are most vulnerable, highlighting the need for a more equitable health care system.


Americans Support Expanding Access
A recent report, Reversible Decay: Oral Health is a Public Health Problem We Can Solve, reinforced the fact that many Americans are unsure or incorrectly believe Medicaid (74%) and Medicare (62%) already cover dental treatment. Regardless of their understanding, 78% of respondents support Medicaid dental coverage and 80% support Medicare dental coverage.
supporting bar chart of patients' understanding of dental benefits

Medicaid administrators also agree that their programs are underfunded. As it stands, 68% of Medicaid state dental directors do not think their state programs adequately budget for oral health care.
The lack of dental insurance coverage means adults continue to struggle to stay healthy, while states and the federal government continue to rack up avoidable costs. Providing, or expanding, adult dental coverage can lead the way to reducing costs for patients, dentists and states, as well as lowering the incidence of diabetes and other diseases and improving overall health outcomes.