Nearly all older Americans support including dental coverage in Medicare

Nearly all older Americans support adding a dental benefit to the Medicare program that covers most people over age 65, according to a new national poll that also reveals how often costs get in the way of oral health for older adults.

Ninety-three percent of people between the ages of 65 and 80 favor including dental coverage in traditional Medicare, though the percentage dropped to 59% when they were asked if they'd favor it even if they had to pay more for their Medicare benefits.

Just over half of the older adults polled (53%) said they currently have dental coverage. Half of this group are covered as employees or retirees, or spouses of employees.

Another quarter said they have dental coverage because they've chosen to get their Medicare coverage through a Medicare Advantage plan offered by a commercial insurance company. In fact, 72% of those with Medicare Advantage coverage said they'd chosen their plan in part because it covered dental care.

Whether they had insurance or not, cost plays a role in dental decisions, the poll finds. One in five of the older adults polled said they had delayed getting dental care, or gone without it, in the past two years.

The majority of these respondents said cost, or insurance problems, played a role in this decision. Those without dental insurance, and those with lower incomes, were more likely to say they'd delayed or gone without oral care.

The new results come from the National Poll on Healthy Aging, carried out by the University of Michigan Institute for Healthcare Policy and Innovation with support from AARP and Michigan Medicine, U-M's academic medical center. It involved a national sample of more than 1,030 adults aged 65 to 80 who answered a range of questions about their own oral health and dental health policy.

These results suggest that health care providers and policymakers should seek solutions to better identify and address how cost and other factors act as barriers to dental care among older adults."

Domenica Sweier, Ph.D., D.D.S.

Sweier, a clinical associate professor at the U-M School of Dentistry, helped develop the poll questions and analyze the results. She adds that as providers and policy makers continue to seek solutions, "This will be important to preventing health and social consequences of unmet oral health needs in this population."

Differences across the over-50 age range

A previous National Poll on Healthy Aging report looked at dental health, including insurance and cost factors, among people in their 50s and early 60s. Only one in four of those polled said they lacked dental insurance, but half said they did not know how they would get dental coverage after they retired and some assumed that traditional Medicare would cover their dental care needs.

"Across the spectrum of ages, dental care and coverage vary, and cost plays a major role," says Preeti Malani, M.D., director of the poll and a professor of internal medicine at U-M with special training in the care of older adults. "We know that poor oral health can affect everything from social interactions to eligibility for surgery, so it's important for health professionals as well as policymakers to understand what older adults are experiencing."

One in four of the adults over 65 polled (27%) said they were embarassed by the condition of the teeth, and about the same percentage rated their overall dental health as fair or poor.

The role of dental care costs

One in three hadn't been to the dentist for preventive care such as a cleaning in at least a year. When the research team cross-referenced this with household income, they found that those with incomes over $60,000 were nearly twice as likely as those with incomes less than $30,000 to have gone to the dentist in the past year.

Nearly half of the poll sample (46%) said they were missing teeth but didn't have a denture or implant to fill the gap.

"Coverage of dental care, as well as vision and hearing care, is critical for the long-term health of our population" says Alison Bryant, Ph.D., senior vice president of research for AARP. "Even simple teeth cleanings may not be affordable to seniors living on fixed incomes, so having coverage for dental benefits may help address that problem."

The poll also shines additional light on the growing body of evidence linking oral health and overall health and wellbeing.

Those who said their overall physical or mental health were fair or poor also visited the dentist's office less often, and were more likely to say their oral health was poor. Problems with dry mouth related to medication use, and challenges eating a healthy diet because of untreated dental problems, could make these issue worse, says Malani.

The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,039 adults aged 65 to 80 who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have them.