Adult Dental Benefit

All adults need and deserve access to oral health care. Without regular preventive care, oral health problems can develop and worsen, leading to overall health and social issues that can harm individuals. We need to protect and expand adult dental benefits — within both Medicaid and Medicare. 

Adult Dental Benefit Illustration

Gaps in Coverage

Within Medicaid, comprehensive dental coverage is mandatory for children, but benefits for Medicaid-eligible adults are optional. And states have flexibility in how they interpret “benefits,” often looking at them for potential cuts when budgets get tight. Not surprisingly, then, Medicaid adult dental coverage varies tremendously across states. 

Medicare suffers from similar gaps: It does not mandate coverage for the treatment of dental disease, nor does it cover most dental care, procedures, or supplies. In fact, nearly half of Medicare beneficiaries, or 26 million people, do not have dental coverage as of 2021

There was momentum behind adding dental to Medicare in the fall of 2021, but the social spending proposal was trimmed, keeping the benefit out of the program for now.

The Need for Reform

Lack of Access

Lack of access to oral health services disproportionately affects older adults of color and those living in rural areas. In 2020, according to a nationally representative survey, 7 in 10 Black Medicare participants and 6 in 10 Hispanic enrollees did not see a dental provider. Roughly 1 in 5 rural seniors have not seen a dentist in over five years.

Read the study

Black and Hispanic Medicare statistic infographic

Medicaid Coverage by State

As of 2020, only 18 states include comprehensive dental benefits in their Medicaid programs. Ten states cover dental care only for emergencies, and three do not provide any coverage at all.

Explore our Medicaid toolkit

Delayed Care

Medicare’s lack of dental coverage is a key reason why many older adults lack access and endure untreated oral health conditions. 

Read communication brief

infographic that cites 1 in 5 older adults cost of care as a reason why they did not seek services

Economic Inequality

Those in poverty spend 10 times more as a proportion of their family income on dental services compared to high-income families.

Read research report

Infographic citing Low income adults spend 10x more of their family income on dental services

infographic showing how overall health impacts

The Costs to the System

Adults without dental coverage often delay treatment until issues become severe or painful. This leads to visits to the emergency department (ED), which are significantly more expensive, costing an estimated $2.1 billion per year. ADA research indicates that nearly 79% of these visits could have been addressed in a dental office, which translates into potential savings of up to $1.7 billion per year.

 

The Risk for Individuals

The lack of preventive care puts people at higher risk not only for dental problems but for other chronic health issues. A growing body of research shows that oral health is connected to overall health. Conditions including pneumonia, heart disease, and diabetes can all be exacerbated by poor oral health. Studies have also suggested that dental problems can lead to increased risk of high blood pressure and dementia.

Advocacy to Protect and Expand Benefits

Advocates have been working hard to expand adult dental benefits — and they’ve made progress. In 2019, at least 14 states implemented legislative or administrative changes to mandate more dental coverage. Still, there is a long road ahead to achieving full coverage for all adults. Providing — or expanding — adult dental coverage can help reduce costs for patients, providers, and states and can lead to better overall health outcomes.

Learn more about our advocacy efforts

female retiree in dental examination chair