Why Medicare Should Cover Oral Health: Cheryl’s Story

This blog is part of an ongoing series of stories from people across the country who need comprehensive dental coverage, but do not have access to it. Families USA, in partnership with the DentaQuest Foundation, has launched an intensive, multi-faceted, long-term issue advocacy campaign, Oral Health For All, to reduce the barriers to oral health coverage that prevent more than 106 million Americans from have such coverage and getting the care they need. 

58 million people rely on the Medicare program, but only one-third of them have any coverage for oral health care.

Seniors of all income levels report that cost is the top reason they forgo a dental benefit. FamiliesUSA and our partners are advocating for Medicare to cover comprehensive dental care.

Families USA’s Oral Health team partnered with Oral Health America, the American Dental Association, and other organizations, to release a joint white paper on the importance and benefits of including a dental benefit in Medicare.

We would like to share just one story about how a Medicare oral health benefit could change someone’s life.

Cheryl in Olympia, Washington, has gone nearly 10 years without comprehensive oral health care.

2008 and the following years was a tough time for many – everyone knows someone who lost a job, or even their home.

For Cheryl, the recession meant a severe cut in work hours and benefits, but it wasn’t her home she was at risk of losing, it was all of her teeth.

When Cheryl’s company came under new management, she was less than a year from retirement. Her dental benefits were stripped to their bare bones, only covering routine cleanings and fillings. All other care required a significant co-pay that was a burden for Cheryl, but she managed because she needed root canals.

Getting oral health care is especially important for Cheryl as she has dry mouth and a receding gum line– a combination in which can cause rapid tooth decay and gum disease no matter how often she brushes and flosses.

Without frequent professional cleanings and dental procedures, Cheryl’s oral health will decline.

“I just want people to know I try and do my best, but without comprehensive care, I can’t keep my teeth healthy no matter how hard I try,” Cheryl presses.

When she retired and lost employer’s coverage, she gained insurance through Medicare and has not been able to afford the dental benefit. Without coverage and on a fixed income, Cheryl cannot afford the root canals and other oral health care she needs. It has been 9 years since she last had dental coverage and it has had a devastating impact on her health.

Cheryl has lost six teeth and has many left that are giving her pain and discomfort. She has trouble with chewing and has to be extremely careful with fibrous foods, such as raw fruits and vegetables. She takes Ranitidine frequently because she just can’t chew down her food enough.

She says, “It’s embarrassing how much I struggle to eat.” So much so that she doesn’t like going out to eat any more.

In retrospect, Cheryl believes that her poor oral health and resulting limited diet contributed to the heart attack she had a few years back.

Knowing how important getting care is, Cheryl visits a dental clinic as often as she can. For $50, she gets a cleaning, an exam, and any fillings covered, but it doesn’t cover the root canals and crowns she desperately needs. Many times when she gets a tooth checked for giving her pain or discomfort, she leaves with medication to treat the pain but not a procedure to fix the problem. She says, “I have $10 for the medication but I don’t have several thousands or even hundreds for the procedures.”

Cheryl isn’t alone. A comprehensive dental benefit to the Medicare program would make a world of a difference for Cheryl and many seniors like her.

It would allow our older adults to live with dignity and healthier lifestyles.

As evidenced by a recent New York Times story and our polling research, adding a dental benefit in Medicare is extremely popular, but few policy makers have even considered the idea. We must show up for our seniors and expand oral health care for all!