Medicare may cover Dental?

 The New York Times recently published an article " Five Decades later, Medicare might cover Dental Care"  This development would certainly help economically disadvantaged elderly patients better afford dentistry but it would likely restrict participating dentists to greatly reduced fees. I think it will most likely amount to "Medicaid Dentistry for the elderly". If this turns out to be the case, this may not be the type of coverage most of my elderly patients really desire, since Medicaid Dentistry amounts to triaged dental expenditures. Most patients who have significant dental problems  get covered for extractions and partial or full dentures, but not for more expensive dental options ( multiple implants and crowns) 

In my dental practice,  elderly patients usually choose  to fix their teeth, even if crowns are needed and when their teeth need to be extracted they often opt for implant based replacements. Implant dentistry is not that inexpensive, especially when their are multiple teeth that need replacing.

The Times article goes on to suggest that maybe this "Medicare coverage" could be need based for  less affluent patients over 65. This makes sense to me as this group needs  and would be grateful for any help our government could supply.  According to the NY Times article" the American Dental Association  leaders say they want Congress to concentrate scarce resources on the patients who struggle the most, wants Medicare dental benefits to be offered only to poorer patients, to be offered by private insurers, and to be included in its own special part of Medicare." 

I believe another option could be an additional  government sponsored "private option" one in which the elderly could pay for a portion of their plan, similarly to the type of supplemental plans offered to those over 65 Who want a more coverage than Medicare B alone provides. This type of coverage would be appreciated by many seniors , who complain that they lost their dental insurance when they retired.

This sort of plan could be subsidized if congress would like to help seniors and could be set up as a PPO plan, similar to the plans many seniors had when they were still working. This is the type of plan that they were used to and would allow them to possibly go in or out of network. This option would tend not to disrupt existing private office participating in existing managed care options. 

It is my fear that congress will opt for a one size fits all approach, with rigid discounted fee schedules similar to those already provided by state Medicaid Plans. This option might disrupt existing private dental practices and further accelerate the already accelerating trend toward a greater percentage of corporate dental practices. While some may point to these practices as delivering more affordable dentistry, it may be the straw that broke the camel's back as far a tradition fee for service , owner operated small dental practices. 

At the moment their are few privately owned pharmacies and many physicians have opted to work for hospitals as employees , rather than maintaining their private medical practices. This pending legislation if not carefully thought out, may have a similar effect on dentistry.