Basic Medicare doesn’t cover dental costs

SPOKANE, Wash.

Turns out, daily oral care for your pearly whites past age 50 can pay dividends beyond a strong bite and bright smile.

People approaching retirement don’t always think about dental care costs adding to the bottom line of living expenses, and it’s a common misconception that basic Medicare covers regular trips to the dentist and certain oral procedures. It doesn’t.

Kathy Finley, 68, got that surprise after she retired from teaching religious studies at Gonzaga University in Spokane. Until about three years ago, Finley had medical and dental insurance through her employer and assumed Medicare would cover similar expenses.

“I didn’t realize until I got to that point that there was no coverage at all for dental under Medicare,” Finley said. Costs of dental visits already have stacked up. While her husband recently secured some dental coverage through Veterans Affairs, she’s had to pay cash for fillings and dental checkups twice a year.

“I’m trying to do that at full cost,” Finley said. “Even though the dentist does a 10 percent discount for seniors, it’s still awfully expensive for our budget.”

A May 2015 Washington Dental Service Foundation survey of 375 adults in Spokane found that 51 percent of respondents said they either believe Medicare covers preventive dental care or they didn’t know if it did. While basic Medicare doesn’t include such provisions, some Medicare Advantage plans cover preventive dental services. But the extra coverage varies by the plan and may not cover such expenses as X-rays, fillings and crowns, according to Aging and Long Term Care of Eastern Washington.

Sometimes, a daily oral health regimen isn’t enough to prevent a huge bill. Joyce McNamee is a 74-year-old widow of a dentist who regularly talks to Spokane seniors about oral health. An advocate of fluoride, she follows a rigorous routine for cleaning teeth. Recently, she faced unexpected dental expenses when a cavity had formed between two of her teeth in a space under a crown. She needed a root canal, followed by restorative work that added up to $2,000 out of pocket.

“From a standpoint of good financial reasoning, I have to have that lower tooth fixed because of the investment I have made in my health,” McNamee said. “I’m not happy about spending $2,000,” she added. “I firmly believe if we had fluoride in water, I would not have had that decay. Most people would pull their tooth because they couldn’t afford it.”

Jerrie Allard, 58, works with Smile Spokane, a partnership of community leaders and oral health experts developing strategies to improve oral health in the community. “Gum disease is linked to chronic diseases including diabetes, heart disease and stroke,” Allard said. “Medicare doesn’t cover dental, so protecting oral health is especially important as we get older.” She and her husband are thinking they should set aside more savings now for any dental emergencies later in life.

Dr. Nick Freuen, a Spokane oral surgeon, said he sees patients regularly juggling those expenses. A large number of them are ages 60 and older who seek care for implants or restorative work because of tooth or gum loss.

In addition to regular oral care at home, he recommends people planning for retirement to save specifically for future dental costs. Even people with insurance often misunderstand what is needed to cover major work, he added.

“People think they’ll be fine, but you run out of $1,000 real quick when you start to do restorative work,” Freuen said. “The biggest problem I see in the elderly is they have a whole lot more risk of dental decay.”

Risk reasons include aging-related dry mouth conditions and lessened dexterity for oral hygiene such as regular flossing, he said. “You probably should see your dentist even more often for oral hygiene,” said Freuen, who also recommends fluoride treatments at the dentist. “People should look back on work they’ve had done in the past, and they should anticipate similar work. If you’re losing dexterity in your hands, consider getting an ultrasonic toothbrush. Drink lots of water, and consider getting some saliva substitutes.”

For examples of costs, a dental implant for an individual tooth can reach $3,000 to $4,000 when including fees for a surgeon, the procedure itself and then paying a dentist for a crown, he said. Implant-supported dentures can easily reach $25,000. Tooth loss impacts nutrition and quality of life, Freuen said. There’s also a psychological component of feeling good, he said, and more people are making the choice of implant-supported dentures because the option is “practically indistinguishable from real teeth.”

“It’s important from a functional standpoint because of the nutrition you can get. With conventional dentures, there’s not a lot of chewing power, so you have a softer food diet.”

Seniors who have talked to McNamee share stories about how loss of teeth and other dental problems link to overall health. “So many of them don’t have their own teeth because they couldn’t afford to have root canal or whatever it took, so that leads to poor nutrition,” she said. “You can’t chew meat; you can’t bite into a crisp apple. If you can’t eat, your health suffers.”

Other health problems also can interact with dental concerns. McNamee’s second husband, Ron McNamee, 70, developed Type 2 diabetes and now sees a dentist every three months because the condition can cause faster decay in the mouth, she said. A recent visit to the dentist found he had four cavities, despite nightly use of a fluoride rinse along with regular flossing and brushing.

Jim Sledge, 71, a retired Spokane dentist, says that while fluoridation, fluoride toothpaste and better oral care have gone a long way toward boomers keeping their own teeth, that dental longevity poses another challenge. “How do people continue taking care of their teeth?” Sledge asked. “When people are approaching retirement, as a dentist, I encouraged them to get any major dentist work done a couple of years before retirement, then put some money away to continue to come to the dentist.”