Do Not Go Gentle Into That Good Night?
INTERESTING STUFF – 4 February 2017

Only 12 Percent of Elders Have Dental Coverage

Just two more appointments, if all goes well, and by the end of February I will be finished at last with a long, complicated dental procedure that began in 2014.

About a year ago, I told you about growing new bone in my upper and lower jaws (a medical miracle in my book), the insertion of titanium posts into the new bone when it had fused with my natural bone and then the attachment of an “overdenture” that has allowed me, as I explained then, to bite into an apple again for the for the first time in a decade.

Overdenture

At that point we were finished with my upper denture and now we are rounding the corner to the finish line on the lower one.

I chose the overdentures because I want a better eating and living experience than the traditional denture but I could not afford a full set of implants that would have allowed me to have teeth as permanent as real ones. Overdentures almost do that except that, like traditional ones, they must be removed every day for cleaning.

The implants and overdenture are an engineering marvel but there is no doubt they are wildly expensive. In total, I spent about $33,000.

Even after more than two years to become accustomed to it, that number causes me almost to stop breathing. These fancy new teeth took a great, big, giant chunk out of my end-of-life fund. (I guess I'll just have to die faster when the time comes.)

As hard as it was to make that decision, I am luckier than most elders; at least I had the money to fret over. Most old people do not. And Medicare, by law, cannot help.

When the Medicare legislation was implemented in 1965, it was a deliberate choice to leave off dental coverage (and prescription drug coverage).

According to a 2016 study from Johns Hopkins Bloomberg School of Public Health, just 12 percent of Medicare recipients (almost all old people) have dental coverage.

In contrast, according to the report of this study in Medical New Today,

”Eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare.”

No kidding, said she with $33K worth of dental work in her mouth. I'm going to quote this story at greater length than usual because I think these next paragraphs are important for you to know. The researchers

”...analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors.

“The other was similar to a proposal that has been introduced in Congress that would embed dental care into Medicare as a core benefit for all of the program's 56 million beneficiaries, which is not expected to pass before Congress recesses. [RB: It did not.]

“The first proposal, which would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn't afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate.

“The second, with a $7 monthly premium and subsidies for low-income people, would cost between $12.8 and $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50 percent of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay.”

That wouldn't help much – actually, implants and/or overdentures and even traditional dentures would not be possible at all in that scenario. But it would be a start for basic care and here is why that is important:

”Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death.

“It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn't have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.”

The study's author, Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School, says that

"'...a staggering 49 million Medicare beneficiaries in this country do not have dental insurance. With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem...'

“'Older adults are struggling and the current benefits structure of Medicare is not meeting their needs. We need to find the right solution,' she says. 'Otherwise, it's going to end up being so much more expensive for everyone.'"

Reading this report a few weeks ago as I was writing the final check for my dental work, gave me both a shudder (I am unaccustomed to writing checks with mid-four figures and will never get used to it) but also a strong sense of gratitude.

As much as I still carry concern about taking such a huge chunk of money out of my end-of-life fund, at least it was there for me to make the choice. How lucky is that – so many elders are not.

But why do I think incorporating even limited dental coverage into Medicare won't happen for at least the next four years?

* * *

RESISTANCE NOTES:
In related news, during the election campaign, then-candidate Donald Trump pledged to let Medicare negotiate discounts for prescription drugs as the Veterans Administration does. Then, early this week,after he met with lobbyists and executives of pharmaceutical companies, reports Matthew Yglesias at Vox:

"...he abandoned that pledge, referring to an idea he supported as recently as three weeks ago as a form of 'price fixing' that would hurt 'smaller, younger companies.' Instead of getting tough, Trump’s new plan is that he’s 'going to be lowering taxes' and 'getting rid of regulations.'"

Yglesias further reports that according to Herb Jackson who was the designated pool reporter that day, Trump told the pharmaceutical attendees:

"I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market. That includes price-fixing by the biggest dog in the market, Medicare, which is what's happening. But we can increase competition and bidding wars, big time.

"So what I want, we have to get lower prices, we have to get even better innovation and I want you to move your companies back into the United States. And I want you to manufacture in the United States. We're going to be lowering taxes, we're going to be getting rid of regulations that are unnecessary."

This is chilling when you extend similar thinking to Social Security and the Medicare program itself that the Republicans in Congress are planning to privatize. Recall that during the campaign, Trump repeated many times that he would not touch those two programs. Riiiiight.

Comments

Even routine cleanings which DH and I have every 6 months is expensive. But we would pay more for dental insurance premiums than we use in a year. So we brush and floss, have cleanings twice a year, and pay for it as we go. BTW, our dentist gives a 7% discount if we pay and they don't have to deal with insurance.

Only in the past ten years have I realized what a marvel my father-in-law's dentures were. He had rickets as a child and his teeth were always weak and gave him trouble. When he graduated from high school an uncle of his, who was a dentist in the small town in which they both lived, extracted them all and built the dentures that he wore for the rest of life. I think he rarely went to the dentist after that, but took meticulous care of his dentures and mouth. I didn't even realize his teeth were false until my husband and I had been married for many years. On one of his falls, at age 90, he hit his mouth when he went down and one of the teeth was knocked loose. I took them to the dentist that my mother-in-law had visited, the dentures were repaired by a local lab and he was back in business until his death more than a year later. He ate apples, corn on the cob, steak, pretty much what ever he wanted and never had a problem. Those dentures probably should have gone into some sort of dental museum as an example of the quality of work that is possible. They had served him beautifully for more than 70 years!

Hopefully, the boomers reaching retirement and the next bunch after them have had much, much better dental hygeine care, flouride, flossing, etc. than my generation (born '36). My childhood dentist used to bribe me with a sucker if I'd sit still for his slow, excruciating drill as he filled my sugar caused cavities. When I was in my 40's I lost three upper molars to gum disease and have had a partial ever since.

My daughters, in their 50s, barely have any cavities at all, have straightened teeth and all of them still there. Granted, there's a certain level of privelege in operation, but flouride alone has made a huge difference across the board.

So, perhaps the aging population of the future will enter retirement and Medicare, if it still exists, with a healthier mouthful of teeth and dentists may be competing for their business.

I was able to continue my dental insurance after I retired from teaching. It's pricey--$89 a month for the two of us, but I'm keeping it in case I need really expensive dental care down the line. Hubby just had a new crown put in so the insurance helped out tremendously.

Couldn't get past you were able to afford $33,000 for dental care!

We have a dental school here in Memphis which is almost free. This an option for people with little money. I have dental insurance which just breaks even each year with cleanings/check ups; it pays half of most expensive work. Once I fainted and fell on my face; I have root canals and veneers which are very costly to replace. Almost all of my teeth have been filled, many of them with gold. Some of the gold fillings I have had for 60 years.

Laura Fox...
I couldn't "afford" it. It cuts terrifyingly deeply into end-of-life expenses and it took me weeks to decide to do it. In the long run - if I live many years - it will save large and unpredictable amounts of money in ongoing dental care. If I die soon, I don't care.

And yes, I am terribly lucky to have had the money and I am grateful for that.

Laura,that IS a lot of money, but having it at all largely a matter of luck, plus the price tag is highly variable based on local custom. Remember, Ronni had to give up a lifestyle she loved by selling her New York apartment, so it's not like she doesn't "deserve" to spend it.

It's almost impossible to get ANY clarity at the beginning about 1) what a dental program is actually going to cost and 2) how effective it is going to be years down the road.

I know several people who spent almost exactly that much on early implants in the 90s, and they are having problems with them now. I had recommended periodontal surgery in the mid-90s, and I swear it made my teeth worse and more painful until they were finally extracted a decade ago for dentures, which are (mostly) trouble-free and comfortable.

My point is, you can pour money into your teeth but *still* may not be able to smile, eat, or plan ahead to have them a reasonable time into the future. Dentists would no doubt reply that you can pour money into *anything* without a guarantee of a good outcome, and that is perfectly true.

If you have the money AND the belief that the treatment is going to work, why not? It doesn't benefit anyone else for Ronni to suffer while the available money just sits there at today's pitiful interest rates. If this works, her life will improve by quantum leaps--a good thing.

As for myself, I just turned down a proposed dental plan that seemed outrageously expensive and speculative to "save" a handful of remaining teeth, and I'm OK with that, at least for now.

With dentists, you can't tell if they know how your teeth are going to end up (and are not telling you because they're greedy) or if they genuinely don't know and are just doing procedure after procedure on autopilot.

And the fact that you truly can't tell doesn't exactly make any patient overflow with confidence. I also wish I'd flossed more in 1973, but that ship has sailed. We all do the best we can with what we have.

My situation is the same as Florence...paying as I go costs less than monthly premiums, and hopefully all will stay in good repair till I'm gone.

Re: Resistance--I find it hard to believe that * could use "vibrantly competitive" in a sentence!

$33, 000 is what I paid for my first house in the 1970's. I do not have dental insurance. I am gambling on good hygiene since the cost would be a third again as much as I pay for two cleanings each year and occasional x-rays or a filling replacement. If something serious happens I will have lost the game.

I live on $780/mo Social Security, in subsidized public housing, and with food stamps, Medicare, and Medicaid. I am so very, very grateful this support. Otherwise, I would be a bag lady for sure. While I am OK in most ways, I am not OK in teeth and hearing. Born in 1948, I grew up in a very poor single-parent home. Dental care was rare and compared to the technologies of today, pretty primitive. So now my world grows ever quieter and my teeth are falling apart and out. No more crunchy or tough (like NY bagels) food for me, including many loved fresh veggies and fruits (only applesauce for me). Right now, most back teeth and a few side teeth are gone and I grow increasingly worried about my quality of life when my front teeth start going. My casual social connections will most likely wither then and I doubt I will continue my public volunteer work, including being a tutor and a conflict mediator, when this happens, a loss to both me and my community. A great many of my senior neighbors have no teeth and consequently stick very close to home, feeling comfortable only around neighbors in the same situation. This is enormously sad to me.

Like Florence, I ran the numbers, and dental insurance premiums would cost more than I normally spend on dental care. I'm lucky to have good teeth in need of only routine maintenance because for whatever reason I'm rather paranoid about dentists.

Very few dental plans can be found (for any price) that cover the exhorbitant costs of implants, especially complex cases involving bone/sinus grafts and multiple teeth. One must have "money in the bank" to even consider this course of treatment.

In researching dental plans last year I stumbled upon some very interesting info about the origins of dental care. Apparently dentists were originally not considered real doctors, and the profession was not held in high esteem. I suppose from there it's easy to see how we ended up in a situation where there is little true dental "insurance" available.

This is so unfortunate since good dental hygiene and dental health are critical to quality (and quantity) of life.

Dental care becomes more and more important as we age. Thanks for sharing your experience.

With the price of a couple of new cars in my mouth (and therefore driving a 14-year-old Prius) I can emphasize with you, Ronni, on the cost of this type of dental care.

Ma Nature and carelessness on my part brought me to that point, and I am eternally grateful that science brought us this technology. It makes all the difference in the world.

Yes, it would be helpful if Dental Insurance could be made available to us elders; perhaps someday it will happen.

Despite receiving terribly deficient care in their youth, most of my original teeth are still where they started. I know I'm lucky and take much better care of them now. My husband and I have dental insurance which, although not cheap ($78/mo), offers some protection against major costs; i.e., root canals, crowns, etc. It has been helpful for us as we've both needed fairly significant dental work over the years.

Almost 10 years ago my dentist stated that he would need to refer me to an endodontist for oral surgery. Being a total dental phobic, I said "No way!" and insisted on looking at alternatives--which turned out to exist. I had a temporary antibiotic implant in the affected area and took antibiotic pills for about 2 weeks. Although he said that these were stopgap measures and wouldn't "cure" the problem, they stopped the gap for almost 10 years and counting.

My luck may run out but, realistically, my 80 Y/O teeth probably won't need to last too much longer. I intend to continue rejecting oral surgery unless it becomes absolutely necessary for my overall health. (In that case I'd also have to consider the risks of the surgery itself, especially since I've always had nasty infections following oral surgery in the past.)

In addition to dental phobia, I now have financial phobia as well! Even with insurance, oral surgery would result in considerable out-of-pocket cost, which we--like most retirees on a fixed income--can ill afford. Glad you're almost done, Ronni!

Catherine Johnston's post above is a carbon copy of my Dad's dentures. He has looked after them meticulously. They have lasted (no visits to dentist etc) for more than 60 years and counting. I thought it was unique, but apparently not so. I tip my hat to the skill of the dentists involved.

We never had dental insurance, hubby was active duty military. One base I did get a little attention from a military dentist I forget how that got through. I might add if the percentages of elders aren't insured I'll guarantee you few children are getting care either.

I suppose you know elders get no Medicare help with hearing aids either.

I've been a cash-pay patient at the dentist office for a quarter century. I assume that even with a small discount for cash, that I am a more profitable patient than one with insurance. I pay immediately, the dentist doesn't have to give me a DEEP discount, and no one has to do paperwork.

Maybe I overestimate the discount insurers negotiate? Am I wrong in thinking that I am a high-profit customer for the dentist?

You may be surprised to learn that dental insurance doesn't do much for major expenses. Most policies are capped annually-ours is $1500 as I found out when I had to have a root canal after my insurance had akready paid for the allowed two annual cleanings. Needless to say I ended up paying a lot out of pocket. The premiums are almost half that so the coverage is really under $800. I find it less expensive to pay as I go.

I am retired. I have health insurance thru my employer. I pay $11 month for dental. It basically covers cleanings and x-rays. I'm hoping my teeth last another 20 years. It's a conversation I've had more than 1X with my dentist. What can I expect as I get older? Both of my parents wore dentures.

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