BY LAUTARO GRINSPAN DECEMBER 20, 2019 07:00 AM
Sonia Domínguez, 74, and her husband, Miguel
Morejón, 81, can’t recall the last time they’ve seen a dentist in Miami, the
city they’ve called home for more than two decades.
“It may have been around three, four years ago,”
said Domínguez. “Probably more.”
At issue isn’t a lack of dental problems, but a
lack of coverage.
After working their entire lives — mostly at a
laundromat — Domínguez and Morejón, from the Dominican Republic and Cuba,
respectively, are now retired and rely on Medicare to access health services.
But as the pair was surprised to find out, their Medicare coverage does not
include dental care.
The alternative, paying for procedures out-of-pocket
— even for straightforward ones like routine cleanings — isn’t financially
viable.
“It’s way too expensive for us. Way too
expensive for people who are retired. And it’s not that we don’t have health
insurance, because we do,” said Domínguez. “No one’s asking to be able to go to
the dentist every single day. But it’s important to go in for a cleaning every
once in a while.”
The last time Domínguez needed to get dental
work done, she packed her bags and traveled to her native Santo Domingo, where
she saw a local dentist for a fraction of the price it would have cost in
Miami.
“You have to make sacrifices. You have to
travel. And all of that gets more and more difficult with age. That’s something
that’s really wrong about the system here,” she said.
Given the conversations she has with friends and
acquaintances her age at neighborhood meal centers, Domínguez knows she and her
husband are
far from the only ones hindered by a lack of access to dental care.
“We get together and I tell them, ‘Oh, look at
the state of your teeth.’ And they tell me, ‘It’s too expensive, too expensive
[to do anything about it],’” she said.
MEDICARE
AND DENTAL COVERAGE
When it comes to oral health, Medicare, the
federal health insurance program for people who are 65 and older, covers only a
small number of medically necessary, non-routine procedures.
Though some can access dental benefits through
supplemental options like Advantage plans, all routine preventive or
restorative procedures are excluded from original Medicare, save for some
limited circumstances during hospitalization.
Spotty coverage — combined with high oral health
costs — means many older adults like Domínguez and Morejón have no path to
getting dental care. According to Justice in Aging, a national non-profit legal advocacy
organization, only half of all 60 million Medicare beneficiaries saw a dental
provider in the past year.
That’s a particularly salient problem for
Florida, given the local demography.
The state has the second-highest number of Medicare recipients in
the country. And within Florida, the county with the largest number of adult
residents over the age of 60, at around 500,000, is Miami-Dade. (At a recent policy forum on the needs of elderly residents,
it was noted that the county’s population has already “tipped,” meaning there
are more folks aged 60 and above than children under 17).
Compounding seniors’ dental care plight in
Florida and across the nation is a trend that seems positive on paper:
nowadays, more and more older adults still have most of their teeth, according
to University of Florida College of Dentistry professor Scott Tomar.
“That’s kind of unprecedented in U.S. history,
for this large a percentage of people to reach age 65 and over with most of
their teeth still in their mouth. In generations past, the vast majority had
full dentures by age 65,” he said. “We are seeing a very, very different type
of older adult now compared to past generations. It’s good news that people are
making it to their senior years with most of their teeth. But the downside is
that we need that much more preventive and restorative care for older adults,
which we as a society are not yet prepared to deliver.”
As Tomar explained, older adults with relatively
intact sets of teeth have an additional vulnerability to worry about: side
effects from medications taken to address chronic illnesses.
“A number of these drugs reduce saliva flow,
which increases the risk for tooth decay,” he said. “So it’s almost like a
perfect storm in the making, what with the avalanche of older adults, baby
boomers, that are now reaching retirement with more teeth than any group 65 and
over ever.”
Upping the stakes for older adults without
access to dental care is that oral health problems can snowball into significant, even life-threatening conditions, including
cardiovascular disease.
RACIAL
DISPARITIES IN DENTAL CARE ACCESS
“When we speak with older adults, lack of access
to dental care is very much top of mind for them,” said Jennifer
Goldberg, deputy director at Justice in Aging. “And that lack of
access to dental coverage has a disparate impact on populations of color.”
In a recent report, Justice in Aging mapped out the extent of
those disparities. It found that seven out of 10 black Medicare beneficiaries
and six out of 10 Hispanic beneficiaries did not see a dentist in the last
year, compared to just four out of 10 white beneficiaries.
Discrepancies in access to care led to
discrepancies in health outcomes, with older adults of color being more prone
to untreated tooth decay and complete tooth loss. That includes, for instance,
Mexican-American older adults. Over one third of them have untreated tooth
decay, compared to just 13 percent of their white counterparts.
“The numbers are just staggering,” said
Goldberg. “And part of this is we know disparities by race and ethnicity are
worse for older adults because the disparities that they have experienced
throughout their lives compound once they get to older age.”
When it comes to addressing those disparities in
oral health access and outcomes for older adults, Goldberg said adding a dental
benefit to Medicare is “certainly the most important thing we can do.”
There’s evidence to back that up. As noted in
the Justice for Aging report, the data available for dental coverage under the
Medicaid program for children shows that having insurance can indeed eliminate
oral health disparities based on race (no similar studies have been conducted
looking at adults).
LOOKING
AHEAD
Earlier this month, House Democrats passed a bill that would incorporate dental — as well
as vision and hearing coverage — into original Medicare.
The bill, H.R. 3, would let Medicare
beneficiaries access preventive and screening dental services, including oral
exams and cleanings, starting in 2025. Patients would be responsible for
covering 20 percent of the cost of those exams, as well as that of other basic
procedures such as extractions and tooth restorations. Major treatments would
also be covered, but patients would have to pay a greater percentage of their
cost.
After clearing the House, H.R. 3 now faces long
odds in the Senate, where a GOP majority is unlikely to take it up.
In the meantime, Morejón, Domínguez’s
81-year-old husband, is feeling some tooth pain and needs to see a dentist.
“It’ll be a matter of waiting a couple of months
before going back to Santo Domingo,” said Domínguez with a sigh. She hopes the
tooth won’t fall before then. “It’s embarrassing to smile and have people
notice that a tooth is missing.”
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