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Response to Elders’ Dental Care Financing Papers

The first wave of the baby boomer generation will begin to retire in the next few years. This generation is one that has seen unprecedented advances in medicine and dentistry. Many of them have been positively impacted by fluoridated water systems and aggressive marketing campaigns by the toothpaste companies, and they have established a twice a year habit of dental visits. Many in this generation will enter retirement having had dental insurance coverage and having taken better care of their teeth than the previous generation. They will also enter retirement with most of their teeth. Many others in this generation will not have had these advantages, though, and will have severe dental and other health problems that will need to be addressed. This entire cohort of people will most likely demand better solutions for their varying dental needs on an increasing basis as we move towards the future.

The three articles in this issue of the Journal of Dental Education that deal with financing oral health care have presented some differing and unique solutions to dealing with the dental needs of the baby boomer generation. The "Prepaid Dental Annuity for Retirement" option proposed by Dr. Max Anderson presents a creative way for middle class working people to begin to plan for their needs in retirement. This is a very forward-thinking approach that will appeal to many who can afford to invest the necessary capital and provide for their potential dental needs in the future.

The article "Financing and Reimbursement of Elder’s Oral Health Care: Lessons from the Present, Opportunities for the Future" by Dr. Judith Jones presents many interesting thoughts. It records the various issues facing financing mechanisms for dental care for seniors including Medicare and Medicaid. Dr. Jones discusses the fact that adult coverage under Medicaid is not uniform across the states, since it is an optional service for those over age twenty. Many states have elected to provide some dental coverage for adults, but in difficult budget times this has been a service considered for elimination. Additionally, Dr. Jones discusses Medicare dental coverage and the IOM report recommending limited expansion of Medicare for additional dental services. She further discusses the idea of a "Part D" for dental Medicare. Unfortunately, the drug industry has already taken "Part D," so this would have to be "Part OH" or another for oral health services. This idea and/or an SCHIP look-alike program for seniors’ dental care are items that need to be considered in any attempt to address future financing of dental care for this population.

Dr. Compton’s article, "Expansion of Dental Benefits Under the Medicare Advantage Program," discusses many issues regarding dental care delivery for seniors and especially those involving the Medicare Advantage program both past and present. Dr. Compton discusses the number of existing dental programs offered through Medicare Advantage, including details of the First Seniority Dental Plan offered in Massachusetts as an option for a broader future plan for such coverage. The significance of the Compton article is in reviewing mechanisms for coverage in connection with Medicare that currently exist or previously existed and as such can be evaluated. Exploring the potential options he suggests should be part of any future discussions regarding the financing of seniors’ dental care.

There are many potential solutions to the dilemma of insufficient coverage for dental care for seniors. Several of these ideas have been presented in the three referenced articles. Some that address Medicare and Medicaid would require either legislation or a change in federal regulations. Other ideas that involve the dental insurance industry would only require that the ideas be "sold" to the appropriate private sector entities for development. All of these ideas should be studied further, considering their cost-effectiveness and cost-utility in regard to overall health.

Finally, in summary:

• Federal participation in any financing arrangements will require enacting legislation or changes to federal regulations that must have legislative support and approval.
  
• Action will need to take place to accommodate the baby boomer generation as they retire and continue to maintain their dentition.
  
• The examples provided in these three articles demonstrate innovative approaches to solving this complex problem that should be studied further.
  
• The dental insurance industry needs to participate in any studies or approaches to solving the problem. There may be great opportunity for them in providing answers to this dilemma.
  

	Footnotes

 
Dr. Davis is the Chief Dental Officer at the Center for Medicare and Medicaid Services. Direct correspondence and requests for reprints to him at 7500 Security Blvd., Baltimore, MD 21244; 410-786-2110 phone; 410-786-9286 fax; conan.davis{at}cms.hhs.gov.

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