Seniors seek affordable dental care options
The lack of dental care insurance from Medicare, the federally funded insurance program for those aged 65 and over, has driven US seniors to seek affordable options for their dental health. Public health researchers are trying to convince legislators to add dental benefits to the Medicare offering by outlining the issues that face seniors as they avoid treating dental issues to save finances. By tackling oral health, legislators can help seniors to avoid worsening their chronic conditions such as pneumonia or diabetes. Less than 50% of Medicare beneficiaries have dental insurance coverage, and only 26% of those with poverty level or lower incomes saw a dentist in 2016. Researchers believe that there are two options for financing the proposed benefits: a $29 monthly premium supplement or an automatic benefit for beneficiaries financed by premiums by 25%. The first option would cost $4.4bn to $5.9bn to implement, and the second around $12.8bn to $16.2bn. Offering dentists a profit margin is also important, the researchers believe, to offer incentives to be involved in the program as a provider.

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Health researchers are hoping to persuade legislators to add a dental benefit to Medicare by highlighting the many seniors forgoing care until their dental health has deteriorated. (Bernard Van Berg/EyeEm )

Like many older people on a fixed income, Ed Slavik knew he couldn't keep up with the high cost of dental care.

So a few years ago, the retired school teacher was relieved to find the Dental Division at Stickney Public Health District, where he had fillings and other routine dental work done for free.

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"It helps a lot because the dental bills can be so expensive," said Slavik, 80, of the Burbank clinic. "They do wonderful work for people."

Slavik, who lives in Burbank, is one of the lucky ones. Medicare, the federal health insurance program for people 65 or older, does not generally cover dental care, and private insurance can be expensive.

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But public health researchers are hoping to persuade legislators to add a dental benefit to Medicare by highlighting the many seniors forgoing care until their dental health has deteriorated, sometimes causing trouble eating, swallowing or speaking, and igniting other health problems.

Amber Willink, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., who led a 2016 study about dental costs and Medicare beneficiaries in the journal Health Affairs, pointed out that a dental benefit could lower the costs of several chronic diseases linked to poor oral health, such as diabetes and pneumonia.

"I think what we're seeing and what people who have researched this area have known for a long time is that our oral health is very much a part of our physical health," said Willink. "As people are living longer, the issues of oral health are really creating bigger issues for the entire body.

"It's not an area we can continue to neglect as people live longer," said Willink.

The study found that less than half of Medicare beneficiaries had dental care in 2016. Only 26 percent of those with incomes below the poverty level saw a dentist. Those with insurance received dental care at about double the rate as those without coverage.

About 17 percent of seniors with teeth have periodontal disease and 18 percent have untreated decay, according to the National Institute of Dental and Craniofacial Research.

The researchers suggest two possible ways of financing the benefit: a voluntary, supplemental benefit financed by a $29 monthly premium or an automatic benefit for every Medicare beneficiary financed 25 percent by premiums or $7 per month. The first plan would cost Medicare $4.4 billion to $5.9 billion yearly and the second $12.8 billion to $16.2 billion, according to the study.

Legislators have proposed a number of Medicare dental bills in the last decade, including two currently pending, though none has passed, noted Willink.

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The study also noted that half of Medicare beneficiaries have yearly incomes below $23,000. Though most states offer dental benefits to adults on Medicaid, the extent varies by state, some offering only emergency care, according to a 2016 report from the Henry J. Kaiser Family Foundation.

Mark Nehring, professor and chair of the Department of Public Health and Community Service at Tufts University School of Dental Medicine, said helping seniors get dental care but also giving dentists at least some profit margin was important.

"That's the key — we want to benefit the patient … and have dentists who see the responsibility as a health provider to provide services at a discounted rate," said Nehring.

Community health programs, public health districts and dental schools are affordable options for some seniors.

The Virtual Dental Home project sends dental hygienists to schools, adult residential facilities, nursing homes and day care programs in California to offer free preventive care and then transmit a full set of digital dental records to dentists.

Paul Glassman, professor of dental practice at the University of the Pacific Arthur A. Dugoni School of Dentistry, who directs the project, said the hygienists were helping keep most participants healthy.

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Glassman said lack of Medicare coverage for seniors' oral health care was a huge problem, which could be worsened by possible future cuts to Medicaid.

"We're seeing a pretty significant change in the population in the U.S. where people are keeping their teeth where they didn't used to. ... The problem is they stop going to see their dentists, either because of finances or mobility challenges.

"The other problem is as people start to get older and sicker and develop more disability and medical problems ... about 400 medications have side effects of causing people to have a dry mouth, so people who haven't had any cavities in their adult lives also start getting cavities because they have no protective saliva," said Glassman.

White Crane Wellness Center in Chicago has a dental outreach program in which dental hygienists perform screening and education at 15 senior centers, referring patients for more extensive work to dentists, dental schools or public health programs.

Being seen at Midwestern University College of Dental Medicine in Downers Grove was a lifesaver for both Karen Putman, 75, and her husband, Edwin Toloczko, 95. The school charges about a third to a half of what local private dentists charge and also offers financial aid for some services if patients qualify, depending on their incomes. About 55 percent of their 11,000 patients are over 55 years old, according to Melisa J. Burton, assistant dean for clinical education. (The University of Illinois at Chicago College of Dentistry also offers discounted dental care.)

The couple, who live in La Grange Park, had spent more than $10,000 on dental work in just a few years, before coming to Midwestern.

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"(The care) was just phenomenal. I saw so many people out there who were really poor, aged and had to go there because they had no resources," said Putman.

Janice Neumann is a freelancer.

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