Unique Oral Health Needs Among Elderly Individuals

More than 65 million people nationwide count on Medicare for their health care, including senior citizens once they turn 65 and many adults with disabilities.

However, this health program doesn’t include comprehensive dental care, a gap that pushes oral health care out of reach. This gap is especially harmful for seniors who live on limited incomes, in rural communities, or who face systemic racial inequities. Simply put, it worsens their overall health and well-being.

Advocates and lawmakers can help.

They can alleviate some of the challenges elderly individuals and others face in accessing oral health care by advancing legislative change. How? Enhancing Medicare with dental coverage is one important policy solution. Another is adding adult dental benefits to Medicaid, which is also a lifeline for millions of adults with low incomes.

Let’s start, though, by highlighting the importance of oral health for older adults.

The Importance of Oral Health for Seniors

America’s elderly are predisposed to more health challenges than younger people. More than half of older adults live with at least two chronic conditions.

Lacking equitable access to dental care compounds the harm of systemic disease and can increase seniors’ risk of life-altering diagnoses:

• Untreated gum disease can make it harder to manage chronic illnesses like diabetes and high blood pressure.
• Adults with poor oral health, including tooth loss, are more likely to develop Alzheimer’s disease and face memory problems.
• Dental disease can also place seniors at greater risk of developing cancer, including in the mouth, breast, and prostate.

Untreated dental disease and tooth loss is also tied to respiratory illness, raising the dangers of COVID-19. Better access to oral health care could reduce these threats, benefiting elderly individuals’ overall health and quality of life.

Dental Problems Facing the Elderly

In the 2023 State of Oral Health Equity in America survey, CareQuest Institute for Oral Health researchers found that 68.5 million adults lack access to dental insurance today.

This study also revealed the extent of the gaps in dental insurance for senior citizens:

• People age 60 and older are most likely to lack dental coverage among all other adults without this insurance.
• One in three adults enrolled in Medicare go without dental coverage.

Within the elderly population, challenges accessing dental care and the resulting burden of disease can be uneven.

Additional CareQuest Institute research shows that the consequences fall hardest on adults confronting structural obstacles, such as geographic isolation, limited transportation, and systemic racism:

• Overall, 7 in 10 seniors have gum disease while one in five has untreated tooth decay.
• One in five seniors who live in a rural area has not visited a dentist in the last five years.
• More than one in four seniors who are Black have lost all of their teeth.
• Hispanic adults are twice as likely to have lost dental coverage in the past year than their white, non-Hispanic peers, making it more difficult to access care.

How Legislative Change Can Improve Elderly Oral Health

Current Medicare policy limits access to necessary dental coverage for the elderly and people with disabilities. It leaves them without the ability to get needed care as they age, contributing to poor oral and overall health.

Policymakers can strengthen Medicare by adding dental coverage to the program. In Congress, in 2021, Rep. Lloyd Doggett (TX-37) introduced the Medicare Dental, Vision, and Hearing Benefit Act. In March of this year, Senators Bob Casey (D-PA) and Ben Cardin (D-MD) elevated the legislation, which would enable more Medicaid and Medicare beneficiaries to access comprehensive dental, vision, and hearing coverage.

“Because of a patchwork of limited health care coverage options for Medicare and Medicaid beneficiaries, many older adults, people with disabilities, and low-income families have inconsistent access to basic dental, vision, and hearing services,” said Casey. “Cost should not be a barrier to care, and all Americans deserve access to comprehensive dental, vision, and hearing coverage, no matter what state they live in or how much money they make.”

Myechia Minter-Jordan, MD, MBA, and CEO and president of CareQuest Institute, applauded this policy development, reiterating the integral link between oral and overall health.

“Dental care is essential health care with direct connections to systemic health, chronic illness, and mental health diseases,” she said.

Oral health care leaders and advocates for older adults can take action for continued progress. Talk with elected officials about the myriad benefits of strengthening Medicare with dental coverage.

Some key points to raise include:

• Tooth decay can worsen chronic illness and raise the risk of other disease, but improving dental coverage would lead to better health for seniors and people with disabilities.
• Black and Hispanic seniors, as well as rural adults enrolled in Medicare, disproportionately go without dental care. Strengthening Medicare with dental coverage would advance health equity.
• This policy change would also bring down health care costs. Among other evidence, one study estimates that providing dental care through Medicare could save $63.5 billion in medical costs over a decade.

Plus, this solution is widely supported. Polling shows that 8 in 10 voters favor adding dental coverage to Medicare.

Additional Solutions to Improve Access to Care

In addition to Medicare, the Medicaid program is a lifeline to millions of seniors and people with disabilities. More than 75 million people across the US count on this health care program, which is jointly funded by states and the federal government.

While Medicaid guarantees dental coverage for children, these benefits end when young people turn 21. It is optional for state Medicaid programs to cover dental services for adults, and benefits vary greatly across states.

CareQuest Institute research from 2023 finds that:

• One in three adults enrolled in Medicaid lacks dental coverage.
• Another 14 million adults may lose Medicaid dental coverage this year due to policy changes stemming from the end of the national COVID-19 Public Health Emergency in April 2023.
• People with low incomes who don’t have dental coverage are less likely to have seen a dentist in the past year, increasing the risks of untreated dental disease.

As the movement to strengthen Medicare coverage advances, advocates and policymakers must continue working to achieve comprehensive adult dental care in Medicaid.

This aspiration would not be fulfilled overnight. Change can happen incrementally, and many policies and other structural factors shape adults’ access to care.

Despite advocacy-driven victories enhancing Medicaid in several states, too many people are being left behind waiting for states to do the right thing. Congress can act to ensure adults enrolled in Medicaid have comprehensive dental coverage.

Polling shows that 65% of Americans support this kind of legislation. Over time — and thanks to the work of tireless advocates and legislative champions — the US could ultimately become a place where we provide good dental coverage for all.

The Urgent Need for Policy Change

These two legislative solutions would significantly advance health equity and improve well-being for seniors and others who count on Medicare and Medicaid. In the wake of the COVID 19 pandemic, the need for change is urgent.

Prior to the pandemic, dental care was already inaccessible for millions of seniors, people with disabilities, and adults with low incomes. Data from 2021 show that one in four seniors had not received dental care in over two years, well before the pandemic began.

In addition to lacking coverage, seniors have cited the high hurdles of cost and inadequate transportation among their primary obstacles to getting needed care. Many of these challenges remain, as senior citizens still bear the ill effects of delaying dental care in the pandemic:

• Medicare-enrolled adults put off oral health care the most of any other health service due to COVID-19.
• Black seniors enrolled in Medicare delayed dental care amid the pandemic for a longer period than their peers in other racial groups, while they and their families were among the hardest hit by COVID-19.
• Fifteen million seniors are economically insecure, a factor keeping care out of reach due to barriers of cost.

Experts are clear that policy solutions like adding dental coverage to Medicare and Medicaid “could have a profound impact on reducing oral health inequities” that the COVID-19 pandemic deepened.

Coverage opens the door to more affordable, regular dental care. It can help prevent oral disease and treat problems before they become emergencies. By moving these legislative priorities forward, we can expand access to dental care, reducing costs and supporting healthier lives for people with disabilities, adults with low incomes, and seniors.