Among adults ages 65 and over, there is evidence of widespread prevalence of dental caries, dental decay, tooth loss, and poor oral health linked to cardiovascular disease, kidney disease, and poor mental health. Moreover, there are substantial differences in dental use by enrollees’ racial and ethnic backgrounds and income, with non-white and low-income enrollees using less dental services relative to white and higher-income enrollees, respectively. Dental care, however, is not covered by traditional Medicare. As a result, elderly adults must typically acquire dental coverage through a supplemental plan, Medicaid (if eligible and if their state Medicaid program provides dental care for adults), or by enrolling in a Medicare Advantage plan that provides supplemental dental benefits. What coverage is available is meager; out-of-pocket spending as a share of total spending for dental care is high among Medicare enrollees with and without dental coverage.

This brief examines the coverage and cost implications of expanding Medicare Part B to include comprehensive dental benefits. The new benefits would be subject to the current Part B deductible and 20 percent cost sharing, and there would be no limit on out-of-pocket spending. We estimate that this expansion would result in a substantial increase in spending on dental services for Medicare beneficiaries but would also dramatically reduce out-of-pocket spending on these services. Medicare enrollees would increase spending on dental care by an estimated 35 percent, but their per capita out-of-pocket spending would decrease by more than $500, a decrease of more than 80 percent relative to current law. Percent increases in dental spending would be higher for Black enrollees and Hispanic enrollees compared to non-Hispanic white enrollees, but the differences in total dollars used for dental services do not narrow between these groups. Similarly, lower-income enrollees would have the highest relative increase in dental spending, but higher-income enrollees would have the largest total dollar increase in dental spending. Medicare spending would increase substantially because of substituting for existing supplementary insurance, Medicaid, and out-of-pocket expenditures and because the new benefit would induce additional utilization and, thereby, additional spending. Altogether, we estimate that expanding Medicare Part B to provide comprehensive dental coverage would increase Medicare spending by about $60 billion in 2023.