Medicare Expansion Could Lead to Improved Oral Health Care for Millions of Older Americans

Oral health is critical for older adults: People at least 65 are more likely than other age groups to experience gum disease, which can worsen the effects of diabetes, heart disease, and other chronic conditions.

Yet Medicare, the federal health insurance program for older Americans and some younger people with disabilities, does not cover dental care. As a result, research indicates, 47% of the program’s beneficiaries—about 24 million people—did not see a dentist in 2018.

Adding a comprehensive oral health benefit to Medicare would help bridge the dental care gap for many who are 65 and older, especially if it covered services by midlevel dental professionals known as dental therapists. Akin to nurse practitioners and physician assistants in medical practices, dental therapists can provide cleanings, fillings, simple extractions, and other routine procedures. For the expansion to be most effective, dental therapists should be recognized providers, and their services should be eligible for reimbursement in both public and private practice settings.

In an Aug. 30 letter to leaders of House and Senate committees considering legislation to expand Medicare as part of the budget reconciliation process, The Pew Charitable Trusts shared research about the many advantages of including dental therapists on the dental team.

Use of dental therapists would benefit Medicare enrollees as well as providers in the states where they are authorized to practice. Research shows that when dental practices and clinics make effective use of these midlevel providers, patients travel shorter distances, spend less time waiting for care, and are generally more satisfied with their experiences. Employment of dental therapists has proved to be cost-effective in private, nonprofit, and federally funded practice settings. In addition, dental therapists help shrink the disparities facing people of color, with disabilities, or living in rural areas, as well those who are low-income or lack access to care and have poorer oral health as a result.

Pew has advocated for policies to expand access to dental care since 2008 with a focus on adding dental therapists to the workforce. These providers are authorized to practice in all or part of 13 states, and over a dozen more are considering legislation to follow suit.

Kathy Talkington directs health programs at The Pew Charitable Trusts, and Allison Corr is an officer with the Pew dental campaign.