Medicare Dental Set Up May Take Years, Interim Policies Could Ease Effects

Inside Health Policy

September 3, 2021 11:35 am

Health care stakeholders are divided on whether CMS can stand up a new Medicare Part B dental benefit in less than three to five years, but say a variety of interim measures could help provide coverage if doing so takes time. Meanwhile, dental plan and dentist associations are pushing instead for a stand-alone, opt-in Medicare dental benefit they say could be created in roughly two years.

Democratic lawmakers are angling to add comprehensive dental benefits to Medicare Part B through the $3.5 trillion budget reconciliation package likely to be voted on later this year. The lawmakers also want to add hearing and vision coverage to Part B.

Adding these benefits is extremely popular with voters across party lines, and getting coverage passed and implemented could be an important political talking point for Democrats going into the 2022 midterms and 2024 presidential election.

But most dental providers aren’t enrolled in Part B right now, and dental care would require an entirely different set of codes. CMS believes enrolling providers and figuring out the rest of the administrative details would take between three and five years, stakeholders told the Washington Post Thursday (Sept. 2). CMS did not respond to Inside Health Policy’s inquiry in the issue.

Melissa Burroughs, associate director for strategic partnerships at Families USA, said she’d give the same timeframe if she were CMS administrator.

But realistically, she believes a Medicare dental benefit could be set up faster. The technical considerations might not take as long as CMS estimates, but that also depends on how Congress decides to phase in the benefit, she said.

Some people on Capitol Hill have discussed phasing in a preventative benefit first, Burroughs said. If the benefit is straightforward and robust, lawmakers could structure the rollout so only part of the benefit needs to be up and running at first, and more can be added on later. That’s the strategy Families USA is hoping Congress will take, she added.

Additional options on the table for phasing in a dental benefit include starting the benefit at only covering 10% of all services and gradually increasing that coverage, as well as offering vouchers for Medicare beneficiaries to purchase private coverage as the Medicare program is set up, Burroughs said.

Others are less optimistic CMS could stand up the benefit in less than three to five years.

One health lawyer said he doesn’t see how it’s possible to cut that time down, given all the moving parts CMS would need to work out in order to operationalize the benefit.

Offering beneficiaries vouchers for private dental insurance would be a great way to provide coverage in the meantime before the next election cycle, the lawyer said.

Wey-Wey Kwok, senior attorney at the Center for Medicare Advocacy, said she couldn’t speculate about whether CMS could get a dental benefit ready faster but said it will take considerable time to prepare a comprehensive benefit that works for beneficiaries. CMA wants to see Medicare cover more medically necessary coverage in the meantime, Kwok said.

Sen. Ben Cardin (D-MD), one of the lawmakers leading the push for Medicare dental benefits, also continues to urge the Biden administration to administratively expand Medicare’s definition of medically necessary dental coverage, he said in a statement to Inside Health Policy. Congress could theoretically bring down the price tag of adding a Part B dental benefit by broadening medically necessary coverage.

Meanwhile, the American Dental Association and the National Association of Dental Plans are both lobbying Congress for an alternative Medicare dental benefit, dubbed Part T, that beneficiaries could opt into. They say a Part B benefit would restrict private market offerings and be generally difficult to implement.

The Part T benefit would be structured similar to Part D coverage. The ADA would like to see this benefit available only to lower-income Medicare enrollees, though NADP says it should be open to any beneficiary.

NADP staff said during a recent presentation on its Part T proposal to insurance stakeholders that setting up Part T would be faster and potentially cheaper than a Part B dental benefit.

Based on the experience plans already have in developing networks, recruiting providers and clearing administrative hurdles around setting up dental benefits, NADP thinks a Part T benefit could be rolled out in about two years, a staff member said.

However, Burroughs and other stakeholders say lawmakers aren’t seriously considering adopting a Part T model at this time. NADP staff also said folks on Capitol Hill seem to be focused on crafting a Part B benefit, though some lawmakers are concerned about how to deal with people who already have private coverage and the effect such a policy could have on Medicare Advantage plans.