MEDICARE

Title 18 of the Social Security Act, is the federal health insurance for persons 65 years and older. It covers over 95% of America's elderly but pays for practically NO dental care. It does not pay for dental examinations, x-rays, dentures, fillings, or cleanings. Medicare will only pay for the setting of fractures of the jaw when performed in a hospital setting. It may also pay for the removal of teeth when completed in a hospital setting--but not their replacement. 

MEDICAID

Title 19 of the Social Security Act, is a federal/state program providing reimbursement for health care services for persons with very low incomes and little or no assets. In order for a state to receive federal matching dollars, it must provide dental services for children. Unfortunately, this requirement does not extend to low-income adults, including the elderly. States can choose to provide dental care to their low-income adults as one of the "optional" services. Although some states choose to do so, most do NOT reimburse for basic oral health services needed by their adult population.

PRIVATE INSURANCE

Of the 30 million persons 65 years and older in 1988, approximately 6% had dental insurance (Wolf SH, Kamerow DB, 1990, p. 817-823). 

OUT OF POCKET EXPENSE

The vast majority of dental services received by older persons is paid for out of pocket. For some older people, this presents no financial problem, but for the many who live within 200% of the federal poverty guidelines, lack of third party reimbursement for dental services is a barrier to care.