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Improving Access to Oral Health Care for Adults in Medicaid: Key Themes from a Policy Roundtable

Medicaid and CHIP programs have made significant strides in improving low-income children’s access to and use of dental care, but access to oral health care for low-income adults lags far behind. To probe current opportunities, challenges, and strategies related to expanding access to oral health care for adults in Medicaid, the Kaiser Commission on Medicaid and the Uninsured convened a group of experts and stakeholders in Spring 2016 to discuss the issues. This brief conveys key themes that emerged from the conversation.

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Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage

This analysis builds on our prior work – Medicare and Dental Coverage: A Closer Look – by analyzing hearing and vision use, out-of-pocket spending and cost-related barriers to care among Medicare beneficiaries as well as hearing and vision benefits in Medicare Advantage plans. It also incorporates top-level findings from the analysis of dental services to provide a comprehensive profile of dental, hearing, and vision benefits in Medicare.

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Policy Options for Improving Dental Coverage for People on Medicare

Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. This brief examines five potential ways to make oral health care more available and affordable for the Medicare population. This brief reviews the limits of dental coverage permitted under current Medicare law, then describes each of the policy options, with an analysis of likely implications for key stakeholders, including Medicare beneficiaries, taxpayers, insurers, and dental professionals

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Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries

Medicare does not cover routine dental care and the majority of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, Medicaid, and private plans, but almost half of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental care. The brief reviews the state of oral health for people on Medicare, describing the consequences of foregoing dental care, current sources of dental insurance, use of dental services, and beneficiaries’ out-of-pocket spending.

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Medicare and Dental Coverage: A Closer Look

Medicare does not cover routine dental care and about half of Medicare beneficiaries do not have dental coverage. Some beneficiaries have dental coverage through other sources, including Medicare Advantage, but 47% of all beneficiaries have not been to the dentist in the past year and many older adults face high out-of-pocket costs for needed dental care. This brief provides new data on the share of Medicare beneficiaries with dental coverage, the share with a dental visit in the past 12 months, and out-of-pocket spending on dental care. It also takes a closer look at the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021.

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The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California.