Navigating Dental Benefits: Adults in Care Facilities

Navigating dental insurance and coverage can be challenging for adults in care facilities, especially when it involves programs like Medicaid or Medicare Advantage. Many residents, family or caregivers face confusion when it comes to understanding what dental services are covered, leaving them unsure how to access the care they need.

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In Washington state, Apple Health (Medicaid) covers dental care for adults, but the benefits are mostly limited to essential services. While routine exams, cleanings, fillings, fluoride applications, and extractions (pulling teeth) are covered, more extensive treatments, like crowns and dentures, may have restrictions. The Washington State Health Care Authority ¹ provides resources to explain these benefits, but navigating the system can still be difficult for many residents and their families.

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For those on Medicare, dental coverage is generally not included in traditional plans. However, some Medicare Advantage plans available in Washington offer dental benefits. Medicare Advantage plans are private insurance options funded by the federal government to deliver Medicare-covered services. These plans serve as an alternative to "traditional" or "Original" Medicare, offering the same benefits while often including additional features like dental or vision coverage.²

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Even though many Medicare Advantage plans offer dental coverage, most enrollees are part of plans that set an annual maximum dollar limit for dental benefits, and the specific coverage caps vary between different plans. This sometimes means enrollees may face challenges in accessing more extensive dental care.³

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This is where minimally invasive dentistry becomes an important solution. With techniques like silver diamine fluoride (SDF) for cavity treatment and prevention, dental providers can provide effective care without the need for more invasive or expensive procedures. This approach is especially beneficial for adults in care facilities, where regular visits to a dental office can be difficult. Research supports the use of these less invasive treatments, showing they can improve outcomes for vulnerable populations while being more affordable.⁴ In 2023, the American Dental Association (ADA) released an updated clinical guideline emphasizing conservative caries (cavity) management.⁵

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In conclusion, while navigating Medicaid and Medicare Advantage dental coverage is complex, minimally invasive dentistry offers a promising, cost-effective way to manage dental care for residents in long-term care. By focusing on prevention and less invasive treatments, we can help improve oral health outcomes for Washington’s most vulnerable adults.

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Looking for additional guidance? Connect with us on via our contact form.

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References:

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1. How do I get dental care? | Washington State Health Care Authority. Accessed October 8, 2024.
2. Medicare Advantage: A Policy Primer. doi:10.26099/69fq-dy83
3. Freed M, Ochieng N, Sroczynski N, Damico A, Published KA. Medicare and Dental Coverage: A Closer Look. KFF. July 28, 2021. Accessed October 8, 2024.
4. Desai H, Stewart CA, Finer Y. Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review. Dent J (Basel). 2021;9(12):147. doi:10.3390/dj9120147
5. Baltimore U of M. American Dental Association Releases New Clinical Practice Guidelines on Caries Restorations. University of Maryland, Baltimore. Accessed October 8, 2024.

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Researched and authored by Dr. Christine Hao, DMD, MPH