White Paper Stresses Importance of Oral Health Care Benefit for Older Adults

Oral Health America (OHA), along with a diverse group of partners, has released the white paper, An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care, which examines the need for oral health care to be integrated with, and elevated to, the same importance as the rest of health care in Medicare for older adults.

The white paper is an interprofessional, collaborative effort written and published by leaders in the consumer, health care and dental fields, including OHA, the American Dental Association (ADA), Center for Medicare Advocacy, the DentaQuest Foundation, Families USA, Justice in Aging and the Santa Fe Group. An Oral Health Benefit in Medicare Part B: It’s Time to Include Oral Health in Health Care looks at many aspects of adding an oral health benefit to Medicare, including medical necessity, costs and the need for legislative changes.

The paper recommends the addition of a comprehensive oral health benefit to Medicare Part B as it covers outpatient services. Such a benefit would be amended to include dental services using the medically necessary and reasonable standard that applies to all Part B services. Advantages to the inclusion of Part B include:

• Ensures that everyone enrolled in Medicare will receive the oral health benefit.
• Provides the greatest number of beneficiaries access to a basic level of oral health care, encouraging equitable health solutions and provider participation.
• Simplifies a potentially confusing program and process for providers and beneficiaries.
• Uses established protections for both Medicare beneficiaries and providers, alleviating the need for a new system and bureaucracies.

To move an oral health benefit in Medicare Part B forward, Congress must pass legislation to remove the statutory exclusion in Section 1862(a)(12) of the Social Security Act. They also must establish dental coverage in Part B, permit payment for preventive services prescribed in the dental benefit and define the dental services in the Medicare Statute.