By: Christopher Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, MA.
A Health Care Provider Defense and Compliance Firm

A Health Care Provider Defense and Compliance Firm. It’s hard to believe, but Medicare still doesn’t cover routine dental care. Despite being the primary health insurance program for older adults, those most at risk for poor oral health, traditional Medicare Parts A and B exclude nearly all dental services. And the impact is undeniable: 1 in 5 adults over age 65 has untreated cavities, nearly 70% have gum disease, and many are struggling with tooth loss, chronic pain, and the nutritional and emotional consequences that come with it.

Oral health isn’t just about smiles. It’s tightly linked to diabetes, heart disease, Alzheimer’s, and other systemic conditions. Yet, nearly half of all Medicare beneficiaries—and two-thirds of Black beneficiaries—haven’t seen a dentist in the last year. The lack of coverage only deepens health disparities and fuels downstream costs.

So what’s being done?

A Hard-Fought Legislative Battle

There was a real push to include dental coverage in the original Medicare program through the Build Back Better Act in 2022. Advocates, public health experts, and even CMS insiders saw an opportunity to bring dental, vision, and hearing care into the fold. But politics intervened.

Despite strong support from consumer groups and health coalitions, the American Dental Association (ADA) opposed the move, arguing about reimbursement issues and administrative burdens. The lack of unity in the dental community gave opponents leverage, and the effort collapsed.

The final version of the law—renamed the Inflation Reduction Act—excluded dental altogether. It was a big loss, but it didn’t stop the movement.

Pivoting to Policy Workarounds

Instead of pushing for comprehensive change through Congress, advocates changed tactics. They looked to CMS’s administrative rulemaking authority—an underused but powerful tool. CMS began carving out coverage for dental services deemed “medically necessary.” That includes dental care prior to organ transplants, head and neck cancer treatments, and cardiac procedures like valve replacements. More recently, CMS has expanded that list to cover patients undergoing chemotherapy, CAR-T therapy, and now those on dialysis for end-stage renal disease.

These administrative changes are real wins. But let’s be clear—they are also limited. They only apply when dental care is directly tied to medical success, and patients must still navigate a fragmented system to get the care covered.

What Needs to Happen Next?

Long-term, only Congress can deliver a comprehensive dental benefit in Medicare. That’s the real goal—and advocates know it. But until then, momentum is building through annual CMS rulemaking and expanding what “medically necessary” dental care can mean.

There are still obstacles. The current administration may prioritize deregulation and cost control over expanding federal benefits. The ADA remains cautious. And Medicare Advantage plans, which already offer limited dental benefits, are seen by some policymakers as the more “market-friendly” path.

But progress depends on staying ready. Advocates must keep public pressure high, build consensus within the dental community, and make the case, over and over, that oral health is essential health. When the policy window opens again, the coalition must be organized, strategic, and prepared to act.

Call to Action

If you’re a healthcare provider, dental professional, or patient advocate navigating these changes—or looking to participate in the next phase of policy development—contact Parrella Health Law at 857-328-0382 or cparrella@parrellahealthlaw.com. We’re here to help you stay informed and ready to lead.