Adult Dental Benefit

According to the Health Policy Institute, 59% of adults aged 19 - 64 have private dental benefits and 7.4% have dental benefits through Medicaid. Medicaid and Medicare dental benefits for adults over 65 are often limited, which means lower income adults and older adults get dental care less frequently than needed. Which, as evidence of the connection between oral health and overall health shows, can lead to more serious health conditions in the future. It’s more important than ever to increase access to preventive dental care by expanding and protecting adult dental benefits.

Benefits Under Medicaid and Medicare
As of 2020, only 18 states have extensive dental benefits as part of Medicaid. Three states have no coverage and 10 cover only dental emergencies. This map provides a snapshot:

Map of the United States showing Medicaid dental benefits coverage for adults

Medicare does not mandate coverage for the treatment of dental disease, nor does it cover most dental care, procedures or supplies. Some Medicare beneficiaries get access to dental coverage through Medicare Advantage plans, Medicaid or private insurance, but benefits vary widely and are often limited when compared to other plans.

Taking Steps to Cut Maternal Mortality in Virginia
In Virginia, partners like DentaQuest and the Virginia Health Catalyst are working to increase the number of dental visits by pregnant women through education, promotion and community-led action. And starting July 1, all adults eligible for Medicaid will have covered oral health care leading up to pregnancy.
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'Many of Them Have Nowhere Else to Go for Oral Health Care'
DentaQuest's 40,000+ oral providers understand the unique circumstances of the underserved Medicaid population. One shining example? Dr. Flavia Lamberghini, a 2020 recipient of a DentaQuest Health Equity Hero award.
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Increased Access Means Lower Costs
Cuts to adult dental benefits could cause ripple effects across society, as highlighted in a recent CareQuest Institute for Oral Health infographic. (DentaQuest is affiliated with CareQuest Institute, an industry advancing nonprofit.) Put another way, expanding dental coverage can save millions of dollars in preventable health costs.

Consider dental-related emergency visits. 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 in the United States. What’s more, research indicates that nearly 79% of these visits could be addressed in a dental office, saving up to $1.7 billion per year.

We also know that a lack of preventive dental 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
A recent DentaQuest 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.

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 accumulate avoidable costs. Providing, or expanding, adult dental coverage can lead the way to reducing costs for patients, oral health providers and states; lowering complications of diabetes and other diseases; and improving overall health outcomes for all.