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Mar 17, 2020

Have you ever wondered why Medicare doesn't have a dental benefit? Wonder why it's a longstanding problem? In this week's episode, Melissa Batchelor, together with her special guest, Taneika Duhaney, talks about the lack of dental coverage by medicare.

She's a dental hygienist and a healthcare administrator for the United States Navy. She was also a health and aging policy fellow who got interested in improving oral health for older adults.

Part One of ‘Lack of Dental Coverage by Medicare_Interview with Taneika Duhaney’

We've done a lot of things to improve our oral health. We've put fluoride in our water, we've developed the ability to put sealants on teeth. That has helped protect people from getting cavities and losing teeth. But as we age, we still see a lot of cavities, people losing teeth, a lot of gum disease. And the biggest reason for that is just the lack of ability to pay for dental services. So, the term oral health refers to your mouth that's free of broken teeth, sores, infections, things like that.

“The development of clinical practice guidelines is important to create age-friendly evidence-based care.” — Melissa Batchelor 

The world health organization ranks oral diseases as one of the top noncommunicable diseases, which means a disease that you get by infection. It is a top problem globally. And so here in the United States, we have people that hadn't seen a dentist in over a year because they're paying out of pocket for dental care and lack of insurance.

Ultimately, what this means is that dental problems aren't taken care of early in the fight. They tend to fester, grow, and this can lead to infections, even hospitalization, and sometimes can also result in death.

The development of clinical practice guidelines is essential to create age-friendly evidence-based care and to improve health outcomes for older adults. If you are an older adult or a caregiver be sure you ask your doctor to look at your mouth. It just might save your life.

Lack of dental care contributes to poor health such as broken or fractured teeth. That can lead to nutritional deficiencies, oral pain, and even infection when the bacteria travels from the mouth to the heart, or it can also cause sepsis.

Part Two of ‘Lack of Dental Coverage by Medicare - Interview with Taneika Duhaney’

There is a lot of legislation right now that supports dental benefits, and it has increased over the years. There's the Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019. This bill would add a dental benefit to part A and part B of Medicare insurance.

Seniors and people with disabilities have access to dental services. They need to manage chronic conditions and support their oral health. There are many programs in place to help children go to the dentist and maintain their teeth, but why is it important for older adults? Why is it so important as we age? If you think of it, kids are covered. You should be up on until 21.

Then they're covered by their employers, a dental benefit most often. Once they become a retiree, there is a health benefit or Medicare. However, there is no dental component for older adults. Since Medicare doesn't offer a dental care benefit except in very limited circumstances, this puts older adults at increased risk. With no Medicare dental options, most older adults skip dental care due to high out of pocket expenses.

“Seniors and people with disabilities need to manage chronic conditions and support their oral health.” —  Melissa Batchelor 

Medicare currently covers medically required procedures. An older adult will get an organ transplant or cancer treatment that's deemed medically necessary. That procedure cannot progress until the individual is in good oral health because of the risk of high amounts of bacteria in their mouth that could potentially travel through their bloodstream during the procedure. 

Often, Medicare will pay for extractions or other dental care that will reduce the number of bacteria. They're not going to pay for crowns, bridges, or anything like that. They're going to pay for the care that's required to immediately reduce the bacterial count in the mouth so that the following medical procedure can continue.

Seniors can pay for a supplemental benefit, but if they're not working, many are on limited incomes. They don't have the financial resources to pay for additional dental care due to out-of-pocket costs starting at about a thousand dollars. That can be financially heavy and cause many to choose between housing or prescription and dental care.

Older adults might be able to seek out community services, community clinics, or community care through local colleges that have dental clinics. Unfortunately, individuals are left to their own devices to try to figure out and navigate what is available in their community, what care they are and aren't eligible to receive, which is the hardest part.

If you can't afford preventive care like having your teeth cleaned every six months, deal with a cavity or a broken tooth, some think it's just cheaper to extract the tooth. We commonly see older adults missing teeth. That is not a normal part of aging. We should be aware of the importance of dental care. Being able to pass on education is significant.

How To Connect With Melissa Batchelor

Melissa B earned her Master of Science in Nursing as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON) in 2000. She enjoyed working with the complex medical needs older adults experienced more than any other population, so after graduation, she started working with a geriatric practice in Wilmington, North Carolina.

She worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits). She transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. She has maintained her clinical practice and board certification, while her primary roles have been as a Nurse Scientist and Nurse Educator. Find out more about her work at