A recent article in the Journal of the American Medical Association (JAMA) calls attention to the vital need to strengthen Medicare coverage for medically necessary oral health services. It stresses the important point that, “The US population is growing older and living longer with chronic illnesses, and the successful management of some diseases is influenced by oral health.”
Titled “Oral Health in Medicare: Considerations for 21st-Century Coverage,” the JAMA article illustrates how Medicare’s longstanding and restrictive dental coverage policy is incompatible with current standards of care for various medical conditions. The authors assert, for instance, that it is “now known that diseases of the oral cavity can adversely affect the success of treatments often covered by Medicare, including heart valve replacements, hematopoietic stem cell transplants, bisphosphonate therapy, and radiation therapy.”
Although Medicare covers medically necessary oral health/dental services in a few circumstances, that coverage is “incomplete and inconsistent.” For example, Medicare pays for an inpatient dental exam prior to a kidney transplant, but not for treatment to resolve any identified dental infections in order to qualify for the kidney transplant. Similarly, Medicare’s dental policy covers tooth extractions prior to radiation directed at the jaw, but will not cover extractions or other treatment for someone who later suffers dental devastation as a direct result of radiation therapy.
The Center for Medicare Advocacy has long championed the view expressed in this article that “[a]n expansion of medically necessary services through a broader interpretation of the existing law could increase access in certain patient populations without a legislative change.” The Center has been working in broad coalition with medical, dental, public health and patient advocacy groups to advance such a coverage expansion administratively.
We firmly agree with the article’s conclusion that “Strengthening the role of oral health in Medicare could allow for coverage (and access) that is more congruent with the changing needs not only of specific individuals, but of the health care system as a whole, acknowledging that without good oral health, complete health is simply not possible.”