According to the Health Policy Institute, 59% of adults aged 19 - 64 have private dental benefits and 7.4% have dental benefits through Medicaid. All benefits are not created equal, however.
Today, Medicaid and Medicare (for adults over 65) dental benefits are often limited, which means adults with lower incomes and older adults get dental care less frequently than they should. That, 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. How can we do that?
One way to improve access for the 7.4% of adults on Medicaid — and for the other 33.6% percent who do not have dental benefits (more than 65 million Americans) — is to expand and protect 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:
Despite positive momentum around expanding benefits heading into 2020, the COVID-19 pandemic and the increasing economic strain it created changed the outlook. States have flexibility in how they set up benefits and often view them as a cuttable expense when budgets get tight. Now, many oral health advocates fear that pandemic-related budget shortfalls could erode progress we made before 2020.
Medicare suffers from similar gaps: It 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 other sources, such as Medicare Advantage plans, Medicaid, or private insurance, but benefits vary widely and are often limited when compared to other plans.
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