Dory Adams, 67, who lives outside of Atlanta, was diagnosed with osteoradionecrosis after radiation therapy she received in 1999 for oral cancer. Sure enough, the radiation weakened the bone in his jaw.
“I endured hours and hours of trauma and pain in the dental chair, and I paid thousands of dollars, only to find out that I lost my battle with osteoradionecrosis,” Adams said. “I live with pain every day with every bite. My jaw creaks and pops when I speak and chew. It reminds me constantly, relentlessly, that I am marked.
But pain is not his only concern.
Since her cancer, Adams has not been able to afford health insurance to cover healthcare needs until she became eligible for Medicare. She now needs to have surgery on her jaw, but post-surgery dental care is currently not covered. Due to concerns about the costs of dental care, surgery, and the intensive care hospital stay, she is delaying surgery.
“Dental care is about quality of life. If I have to have this surgery to save my jaw and end up without teeth on my lower jaw, how will it affect my quality of life? I’ve been so depressed lately that all I can think of is death, ”Adams added. “What am I going to do? I really don’t know. For now, I’ll just take the meds, avoid difficult foods, and try to pay special attention to my remaining teeth.”
She is among the roughly 24 million Americans on Medicare – nearly half of all Medicare beneficiaries in 2019 – who had no dental insurance coverage and could not afford to pay out of pocket for dental care. The same rate of Medicare beneficiaries did not see a dentist in the past year, with blacks, Hispanics, Native Americans and low-income Americans disproportionately affected.
The average costs of routine dental procedures far exceed the average monthly Social Security benefits that many Medicare beneficiaries rely on as their only or main source of income.
But part of the Biden administration’s Build Back Better plan could offer some help – as long as it survives the cuts wanted by centrist Democrats who want to slash the $ 3.5 billion price tag of legislation. The bill wants to expand Medicare to include dental coverage for the millions of elderly and disabled Americans enrolled in the program, in addition to hearing and vision coverage.
Dental coverage would begin on January 1, 2028, including preventive, basic and major dental treatments, including a full or partial set of dentures every five years. A 20% cost sharing would be put in place for beneficiaries to cover prevention, screening and basic services, which would increase to 50% by 2032.
Senator Bernie Sanders insisted that the Medicare extension is “non-negotiable.”
The majority of Americans support expanding Medicare to include dental coverage. A CBS / YouGov poll of more than 2,000 Americans in October found that 84% of them support federal funding to expand medicare to include dental, vision and hearing coverage.
“Dental care is so expensive without insurance that it is often overlooked. It’s America’s number 1 medical service that is jumping because of costs, ”said Melissa Burroughts, who leads the Oral Health for All campaign for the Families USA advocacy group.
Oral health insurance coverage, if Congress adds it as it is currently considering, would mean that more than 60 million seniors and people with disabilities would not only be able to afford dental care. really important, but would also be healthier and benefit from inferior health care. costs.”
The American Dental Association opposes the proposal to expand Medicare to include dental coverage, instead advocating a means-tested version of dental coverage for seniors with an annual income of around 39. $ 000 and less. Medicare advocates have criticized this alternative policy, citing the various risks associated with expanding means testing for Medicare beneficiaries that could undermine the program and reduce access and affordability. care.
Julie Carter, senior federal policy associate at the Medicare Rights Center, described the many health and social issues that can arise if Medicare beneficiaries cannot afford dental care, ranging from the aggravation or the cause of problems serious health problems to people unable to eat or avoid social interactions due to poor oral health.
“We think it should never have ruled out dental care and we really want a full advantage within the Medicare program to combat all of these issues,” Carter said. “We don’t want it to be a stand-alone program, we want it to be part of the Medicare program and to be treated as the integral part of the body which is the mouth. We really hope that something is happening that can really make this care possible. “