As part of their $3.5 trillion budget plan, Democrats hope to expand Medicare to include, among other additions, coverage for dental benefits by 2028.
It’s a dream progressives have been pursuing for years. Sen. Bernie Sanders, I-Vt., called for the changes in his 2016 and 2020 presidential campaign platforms. House Speaker Nancy Pelosi, D-Calif., recently said she’s “all for” expansion.
But adding dental coverage to traditional Medicare is imprudent and unnecessary. In the long run, it could even reduce seniors’ ability to access quality dental care—if any care at all—contrary to its backers’ intent.
For starters, the cost would be massive—about $238 billion over the next decade.
Expanding traditional Medicare to cover dental benefits is also duplicative. About half of Americans aged 65 to 80 have dental insurance. Many of them have that coverage through privately administered Medicare Advantage plans, which cost about $20 per month, on average, in premiums. Almost 90% of Medicare Advantage’s 26 million beneficiaries have dental coverage through the program.
Medicare Advantage is becoming more and more popular, so those numbers are sure to grow. The share of Medicare beneficiaries covered by Advantage plans has grown from 13% in 2005 to more than 40% today. It’s expected to approach 50% by the end of this decade.
Very few seniors—less than 10%—with incomes above the level at which they’d qualify for Medicaid, the health coverage program for the poor, say they’re prevented from buying dental coverage because of the cost.
In other words, well-off seniors are likely to capture much of the benefit of a public dental option in traditional Medicare. Adding dental benefits to traditional Medicare would also disrupt the thriving Medicare Advantage market. Seniors with Advantage plans may switch to traditional Medicare if the newly expanded version of the program is less expensive for them. That’s a virtual certainty, given that Medicare pays healthcare providers less than private insurers do.
Dentists may respond to low reimbursements from a new crop of beneficiaries covered by traditional Medicare by raising rates for everyone else—the privately insured, including those on Medicare Advantage, and those who pay out of pocket.
They may also limit the number of traditional Medicare beneficiaries they’ll see. And that could lead to seniors having dental coverage but not being able to use it.
Look at what happens in the United Kingdom, where patients living under the government’s National Health Service routinely can’t find dentists who will see them. Even if they do, they’re not typically availed of the latest procedures and restorative services, such as crowns and implants. Instead, they simply have problem teeth extracted, because it’s cheaper.
Most have to pay out of pocket for private treatment—a growing trend across the country, particularly among NHS patients on long waiting lists. Less well-off Britons who cannot afford to pay for private treatment have resorted to pulling their own teeth or gluing crowns on themselves.
The American Dental Association has come out against the Democrats’ plan—and argued instead for targeted aid to low-income seniors, whether through Medicaid or other programs. That makes a lot more sense than borrowing hundreds of billions of dollars from the next generation of taxpayers to fund inferior dental benefits that many seniors today don’t want or need.
Democrats may be budgeting as if there’s no limit to the amount of money the government can spend. But the laws of economics dictate otherwise. Adding dental benefits to Medicare is too costly—for taxpayers, for privately insured patients who will see their dental bills go up, and for seniors who will find themselves facing long waits for care.