Oral Health Care’s Equity Conundrum – Essential for All, Out of Reach for Many

Oral health is key to everyone’s overall health and wellness, employment opportunities, economic stability, and social connectedness. But for far too many people, affordable and high-quality dental services are out of reach. Significant disparities exist among who does and does not have access. People of color, rural area residents, immigrants, and people with disabilities are all too often shut out of the oral health system despite the fact that many of these individuals experience also face other challenges such as economic instability, contaminated drinking water and insufficient transportation that contribute to and worsen these oral health inequities.

For many people without health insurance, oral health care is too expensive. For example, the average cost of a root canal typically costs between $750 and $1,200.¹ Because of this, dental care remains the number one medical service families skip due to cost.² According to CareQuest Institute research, 93% of individuals living in poverty have unmet dental needs, compared with 58% in high-income families.³

Progress In All 50 States

On the bright side, there is movement on the state level to increase adult oral health coverage access. From 2020 to 2022, nearly half of all states expanded their Medicaid adult dental benefit offerings to better meet the oral health needs of low-income adults. Five states increased the amount of per member spending, and three states implemented benefits for the first time to some or all the adults who rely on Medicaid in their state. In 2023, an additional five states had new or expanded benefits go into effect.⁴ In every state, Medicaid now offers some kind of oral health benefit (although roughly a third of states only offer emergency coverage or postpartum coverage.)⁵

Outside of Medicaid, the Biden administration has been making important strides within their authority towards greater coverage in Medicare and private marketplaces. Within the Medicare Physician Fee Schedule, the Centers for Medicare and Medicaid Services (CMS) are clarifying their definition for which medical conditions allow for dental care when medically necessary for the improvement of the medical condition. In 2023 and 2024, the administration has ensured that older adults and people with disabilities who rely on Medicare and are getting treatment for medical needs – including but not limited to transplant surgeries, cardiac conditions, and head and neck cancers – will not have to decide between getting the dental care they need or filling their fridge.

In addition to improving coverage in Medicare, the Biden administration recently announced efforts to help states ensure better oral health access through the private marketplaces. When the Affordable Care Act passed, adult oral health was not one of the required essential health benefits for state-based marketplaces. However, for the 2025 Notice of Benefit and Payment Parameters proposed rule, they have offered to allow states to apply to add this additional benefit to their exchanges. In our formal comment, we urged the administration to include this change in their final rule when they publish it later this year.

These critical advancements will help ensure families have access to affordable oral health coverage. And advocates continue the drum beat for more comprehensive benefits in every state and are encouraging CMS to guarantee other key medical conditions include medically necessary dental coverage. But many states are reaching the bounds of what expansions are possible and millions of families will still be out of reach of affordable oral health care.

Congress Must Act

It’s time for Congress to build on states’ oral health care progress and act now. They hold the responsibility to achieve more significant improvements, such as:

• Creating a comprehensive oral health benefit in Medicare
• Requiring comprehensive, mandatory benefits in Medicaid

The current lack of coverage for oral health services in Medicare and the spotty, ever-changing coverage for adults who rely on Medicaid are fundamental gaps. Currently, two-thirds of older adults and people with disabilities who rely on the Medicare program for their insurance, often living on fixed incomes, do not have any source of oral health coverage. Adding an oral health benefit to Medicare would allow 60 million older adults and people with disabilities to access dental care.⁶

A Medicaid oral health benefit in would provide critical whole-person care for millions of people, and save our health system $2 billion annually. because fewer people would rely on emergency departments to alleviate their dental pain. And the data show that states offering more comprehensive care spend less per person on dental care than those that don’t or only offer emergency coverage.⁷

Congress has both the power and the responsibility to enact policy changes acknowledging the reality that good oral health is central to overall health and financial stability, especially for the millions of individuals and families experiencing poor oral health due to cost and inequities. Members of Congress will spend this election year explaining their agenda for the 119th Congress. Improving oral health in Medicare and Medicaid for those who need it most must be on the list.

Footnotes:

¹ Colgate, “What Root Canals Cost And Why The Cost Varies,” January 9, 2023, https://www.colgate.com/enus/oral-health/root-canals/what-root-canals-cost-why-cost-varies

² Eliot Fishman, “Why Strong Health Care Policies in Reconciliation Are Necessary to Advancing Racial Equity,” Families USA, October 2021, https://familiesusa.org/wp-content/uploads/2021/10/COV-2021-349_Why-StrongHealth-Care-Policies-in-Reconciliation-Are-Necessary-to-Advancing-Racial-Equity.pdf

³ Carequest Institute of Oral Health, “Health Equity,” https://www.carequest.org/topics/health-equity

⁴ https://www.carequest.org/about/blog-post/five-key-takeaways-about-medicaid-adult-dental-benefits-2023

⁵ https://nashp.org/state-tracker/state-medicaid-coverage-of-dental-services-for-general-adult-and-pregnant-populations/

⁶ Melissa Burroughs, Eliot Fishman, Garrett Hall, Jen Taylor, “What’s at Stake for America’s Families: Why Congress Must Go Big and Bold in Reconciliation to Improve Health and Health Care for Millions of People,” Families USA, September 2021, https://familiesusa.org/wp-content/uploads/2021/09/COV-2021-262_Whats-atStake-Report.pdf

⁷ Melissa Burroughs and Colin Reusch, “New Data: Medicaid Adult Dental Coverage is Wise Investment for Economic Recovery, Health,” Families USA Insights Blog, July 8, 2021, https://familiesusa.org/resources/new-datamedicaid-adult-dental-coverage-is-wise-investment-for-economic-recovery-health/