Summary Traditional Medicare does not cover routine dental care, but little is known about transitions in dental outcomes upon achieving Medicare eligibility at age sixty-five. Using data from the 2010–19 Medical Expenditure Panel Surveys, we examine dental insurance, utilization, and outcomes among U.S. adults before and after age sixty-five, using a regression discontinuity design and regression analysis. segmented. Among 97,108 American adults representing a weighted population of 104,787,300 people, complete edentulism , or the loss of all teeth, increased by 4.8 percentage points by age sixty-five, and the percentage of people who received restorative dental care decreased by 8.7 percentage points. Enrollment in Medicare Advantage, which may offer a dental benefit, was not associated with greater use of dental services compared with traditional Medicare, and Medicare Advantage enrollees had a significantly larger drop in private insurance dental spending over time. age sixty-five than traditional Medicare enrollees. . Expanding Medicare to cover dental services can help offset these effects among all enrollees. |
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For nearly 1 in 20 adults, Medicare eligibility was associated with losing all of their teeth
Half of all seniors in the U.S. lack dental insurance , and in 2018, nearly half of seniors did not receive dental care. A new study by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, examined changes in dental care and oral health after older adults become eligible for Medicare, the traditional version of which covers medical services, but not dental care. Among more than 97,000 people, researchers found a dramatic drop in the percentage of people who received restorative dental care and a nearly 5 percentage point increase in the number of people who lost all their teeth after turning 65 and became eligible for Medicare. Their results are published in Health Affairs .
"Older adults have the lowest dental insurance rates in the U.S. and cost is a major barrier for many seeking dental care," said corresponding author Lisa Simon, MD, DMD, a resident in the Department of Medicine at Brigham. “We know that Medicare, by covering medical services, improves health outcomes and reduces racial health disparities among older adults, but it has exactly the opposite effect for dental care.”
With very limited exceptions, traditional Medicare does not cover dental services. Medicare Advantage plans may offer dental services, but the scope of coverage varies. Federal efforts to expand Medicare dental coverage have not been approved, and policy debates over dental benefits continue.
Simon and colleagues analyzed national data from the Medical Expenditure Panel Surveys from 2010 to 2019, examining changes in dental insurance and oral health care immediately after respondents became eligible for Medicare. Surveys included community-dwelling adults ages 50 to 85.
The team found that both traditional Medicare and Medical Advantage beneficiaries experienced immediate and long-term reductions in the use of dental services after Medicare enrollment. While the total number of annual dental visits did not change, the number of visits for restorative procedures, such as fillings or crowns, decreased by 8.7 percent. Adults also experienced an increase in complete edentulism (loss of all teeth), which puts people at greater risk of poor nutrition, lower quality of life, and progression of cognitive decline.
“Tooth loss can have a number of negative side effects,” Simon said. "It is associated with many geriatric conditions, including frailty and cognitive function."
The authors note that the survey data used did not allow them to follow participants for long periods and the changes detected could be confounded with other life changes at age 65, such as retirement or receiving Social Security income. Using other forms of survey data could help researchers focus on at-risk populations, such as adults living in long-term care facilities, and could help identify and compare dental benefits offered by Medicare programs. Advantage.
“Without dental coverage for adults who are eligible for Medicare, we are seeing an increase in tooth loss after age 65 among nearly 1 in 20 adults, representing millions of Americans,” Simon said. “Our findings capture the magnitude of the problem, but also point to the opportunity to improve oral health care access and outcomes, should policymakers expand Medicare coverage to include dental services.”
Funding : This research was supported by the National Institute on Aging, National Institutes of Health (NIH) (Grant No. K23 AG058806), Office of the Director, NIH (NIH Director’s Early Independence Award, DP5-OD024564 ).
