This week, Medicare Rights celebrates a Biden-Harris administration announcement that it would be extending its interpretation of medically necessary dental care. This decision ends a decades-long policy that unnecessarily limited access to life- and health-saving treatment for people with Medicare.
Medicare Part B currently pays for some dental services under very narrow circumstances when that service is integral to medically necessary services needed to treat a beneficiary’s primary medical condition. Many individuals need dental care because oral conditions or infections impede the safety of or access to other medical services. While some Medicare Advantage plans include some dental coverage, such coverage is generally quite limited and leaves people in Original Medicare with few options.
We have long believed that the Centers for Medicare & Medicaid Services (CMS) has the authority to allow Medicare to cover a broader scope of medically necessary care than it previously asserted. This final rule is the result of the administration reconsidering its previous position and determining it was too narrowly framed.
Under the new framing, Medicare can pay for dental services under various clinical scenarios, including surgical procedures like cardiac valve replacement, organ transplants, and cancer treatments. The administration is also establishing a process to identify and cover additional dental services that are inextricably linked and substantially related and integral to the clinical success of other covered medical services.
We applaud the administration’s decision and believe that this clarified definition will help mitigate some of the current issues people with Medicare have in accessing needed oral and dental care. We will continue to advocate for coverage of oral and dental care under other clinical scenarios that make such care medically necessary.
In addition, while this decision is a vital step toward integrating oral health into whole-body health, we will continue our work to add a much-needed comprehensive dental benefit to Medicare. We regularly hear from callers to our national helpline that they cannot afford dental care and regularly go without critical care.