While routine dental services are not covered by Medicare, many Medicare beneficiaries have access to some dental coverage through other sources: nearly half of all Medicare beneficiaries are enrolled in Medicare Advantage plans, almost all of which offer dental coverage as an extra benefit, but the scope of coverage varies by plan. Lack of dental care can exacerbate chronic medical conditions, such as diabetes and cardiovascular disease, and contribute to delayed diagnosis of serious medical conditions. Among those who used dental services, average out-of-pocket spending was $874 in 2018. For example, in 2018, half of Medicare beneficiaries did not have a dental visit (47%), and cost was a major barrier to care for those who reported they couldn’t get dental care in the past year. Limited or no dental coverage contributes to Medicare beneficiaries foregoing routine and other dental procedures. Since its establishment in 1965, Medicare has explicitly excluded coverage for dental services, except under limited circumstances. Medicare coverage of dental services is generally very limited While these changes are projected to benefit a small number of Medicare beneficiaries, they do not represent a broad expansion of Medicare coverage of dental services and will not substantially increase Medicare spending or covered dental services for a large number of Medicare beneficiaries. Further, based on changes in the 2024 rule, Medicare will cover treatment to address dental complications after radiation, chemotherapy, and/or surgery for head and neck cancer, as well as dental or oral examinations prior to chemotherapy, chimeric antigen receptor (CAR) T-cell therapy, and the administration of high-dose bone-modifying agents when used in the treatment of cancer. These rules modestly expand the types of dental services that are covered under Medicare, including dental or oral examinations prior to any organ transplant surgery, cardiac valve replacement or valvuloplasty procedures, beginning in 2023, and dental or oral examinations prior to treatment for head and neck cancer beginning in 2024. This brief describes current law related to coverage and payment for dental services under Medicare and the rationale for changes to current policy, explains changes to dental payment and coverage included in these rules, and discusses the impact on Medicare and beneficiaries. The 2023 rule clarifies CMS’s interpretation of when medically necessary dental services can be covered and codifies certain payment policies, and both the 20 rules define new clinical scenarios for which Medicare payment can be made for dental services. ![]() In both the 20 Medicare Physician Fee Schedule Final Rules, the administration made changes to Medicare payment policies for certain dental services, in addition to other payment and policy changes. Medicare does not offer broad coverage of dental services under traditional Medicare, but through recent regulatory action, the Biden Administration has taken steps to modify Medicare payment policies to expand the types of dental services that are covered. Note: This is a revised and expanded version of an analysis that was initially published on December 8, 2022.
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