Only 12 percent of older Americans have some form of dental insurance and fewer than half visited a dentist in the previous year, according to new research on Medicare beneficiaries by the Johns Hopkins Bloomberg School of Public Health.
Having dental insurance appeared to be the biggest predictor of whether a person received oral health care. Only 27 percent of those without dental insurance visited the dentist in the previous year, compared to 65 percent with dental insurance.
Unsurprisingly income also played a role: High-income beneficiaries were almost three times as likely to have received dental care in the previous 12 months as compared to low-income beneficiaries, 74 percent of whom reported receiving no dental care. Many high-income beneficiaries – even those with dental insurance – paid a sizable portion of their bills out of pocket.
The report, ““Dental Care and Medicare Beneficiaries: Access Gaps, Cost Burdens and Policy Options” was published in the December issue of the journal Health Affairs. It’s findings suggest an enormous unmet need for dental insurance among those 65 and older in the United States, putting older adults at risk for oral health problems that could be prevented or treated with timely dental care, including tooth decay, gum disease and loss of teeth. It also highlights the financial burden associated with dental visits, among both the insured and uninsured.
“Medicare is focused specifically on physical health needs and not oral health needs and, as a result, a staggering 49 million Medicare beneficiaries in this country do not have dental insurance,” says study author Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School. “With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem.”
According to the Bloomberg School research, eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare.
The vast majority of Medicare beneficiaries who have dental insurance are those who are still covered by employer-sponsored insurance, either because they are still working or because they are part of an ever-dwindling group of people with very generous retiree medical and dental benefits.
For the new study, the researchers analyzed data provided by 11,299 respondents to the 2012 Cost and Use Files of the Medicare Current Beneficiary Survey. The data included information collected on income, dental insurance status, dental health access and out-of-pocket expenditures.
Among the findings: On average, Medicare beneficiaries reported spending $427 on dental care over the previous year, 77 percent of which was out-of-pocket spending. An estimated seven percent reported spending more than $1,500. Dental expenses, on average, accounted for 14 percent of Medicare beneficiaries’ out-of-pocket health spending.
Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death. It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn’t have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.
“Older adults are struggling and the current benefits structure of Medicare is not meeting their needs. We need to find the right solution,” Willink says. “Otherwise, it’s going to end up being so much more expensive for everyone.”
One cost-saving solution is dental savings plans. An alternative to traditional dental insurance, dental savings plans enable you to save 10%-60% on your dental care. And unlike dental insurance, with a dental savings plan there are no annual spending caps, waiting periods, approval process or restrictions on pre-existing conditions.
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