Joe Martinez for Kaiser Health News
William Stork needs a tooth out. That’s what the 71-year-old retired truck driver’s dentist told him during a recent checkup.
That kind of extraction requires an oral surgeon, which could cost him around $1,000 because, like most seniors, Stork does not have dental insurance, and Medicare won’t cover his dental bills. Between Social Security and his pension from the Teamsters union, Stork says, he is able to live comfortably in Cedar Hill, Mo., about 30 miles southwest of St. Louis.
But that $1,000 cost is significant enough that he has decided to wait until the tooth absolutely must come out.
Stork’s predicament is at the heart of a long-simmering rift within the dental profession that has reemerged as a battle over how to add dental coverage to Medicare, the public insurance program for people 65 and older — if a benefit can pass at all.
A once-in-a-generation opportunity
Health equity advocates see President Biden’s Build Back Better agenda as a once-in-a-generation opportunity to provide dental coverage for those on Medicare, nearly half of whom did not visit a dentist in 2018 — well before the pandemic paused dental appointments for many people. The rates were even higher for Black (68%), Hispanic (61%) and low-income (73%) seniors.
The coverage was left out of a new framework announced by Biden on Thursday, but proponents still hope they can get the coverage in a final agreement. Complicating their push is a debate over how many of the nation’s more than 60 million Medicare beneficiaries should receive it.
Advocates of dental coverage for everyone on Medicare find themselves up against an unlikely adversary: the American Dental Association, which is backing an alternative plan that would give dental benefits only to low-income Medicare recipients.
Medicare has excluded dental (and vision and hearing) coverage since its inception in 1965. That exclusion was by design: The dental profession has long fought to keep itself separate from the traditional medical system in order to preserve the field’s autonomy.
Dental care and health are intertwined
More recently, however, dentists have stressed the link between oral and overall health. Most infamously, the 2007 death of a 12-year-old boy that might have been prevented by an $80