An important part of general health and well-being is oral health. 1 Poor oral health can have a negative impact on people’s overall health and quality of life, even if they receive preventative care, regular self-care, and early detection, treatment and management of disorders. 2 People with low income have a disproportionately high rate of dental illness and tooth loss because they lack access to dental coverage and care. In addition, there are significant racial and ethnic differences in these measurements.
Dental health screening and diagnosis and treatment are included in Medicaid’s entire required benefit package for low-income Americans. Dentists in low-income families are now more likely to receive preventive dental care and primary dental care because to Medicaid and CHIP, which have made significant progress over the past decade. With a comprehensive benefit package, securing dental practitioners and services has remained a major difficulty. Low-income adults in Medicaid have a more complicated situation than children. There is no federal mandate for Medicaid to fund dental care for adults, but most states do so at their own discretion, and the coverage is often limited to extractions or emergency procedures. Medicaid’s adult dental services are often the first to be curtailed when states are facing budgetary issues. 3 Another thing to keep in mind is the lack of dental benefits under the Medicare program, which covers the elderly and those with disabilities.
As evidence of the significance placed on oral health by legislators, both Medicaid and CHIP include comprehensive dental coverage for children and pediatric dental care is one of the ten EHBs under the Affordable Care Act (ACA). Oral health benefits for low-income persons can now be established in new ways. The ACA’s extension of Medicaid to non-elderly people with incomes up to 138% of the federal poverty line (FPL) and changes to the Medicaid payment and delivery systems are all important policy levers to consider. This brief explores the oral health condition of low-income adults, the dental benefits offered by state Medicaid programs, and the current access of low-income people to dental care in order to assist influence federal and state action on adult oral health care access.
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Why adult oral health is important
The consequences of untreated oral illness can be dire. A person’s appetite and ability to eat can be negatively affected by untreated oral health issues, and tooth loss is a common consequence. Chronic pain can disrupt daily tasks such as speech or sleep if untreated problems go unaddressed.5 Research has also found links between diabetes, heart and lung disease, stroke, and poor birth outcomes and chronic mouth infections. Working individuals are predicted to lose 164 million hours each year owing to oral health issues or dental visits because of their work. Adults in lower-paying jobs, such as customer service, miss up to four times as many days of work as those in higher-paying occupations because of dental problems. Tooth decay and tooth loss can have a negative impact on an adult’s ability to land a job.
Dental disease prevalence in nonelderly adults
Dentists estimate that 27% of Americans aged 20 to 64 have untreated dental caries, yet the disease burden does not fall equally on all of us. People with incomes below 100 percent of the federal poverty level (FPL) have the highest percentage of untreated dental caries (44 percent) – more than twice the rate (17 percent) of adults with incomes above 200 percent of the FPL . Oral health issues disproportionately afflicted people of color and ethnic minorities. Because of their higher rates of poverty, Black and Hispanic adults had much higher rates of untreated caries than Whites.
Medicaid’s role in covering low-income adults
Twenty-eight million persons under the age of 65 had Medicaid coverage in 2014. It provides coverage for four out of every ten non-elderly adults who are in poverty. According to the Affordable Care Act’s (ACA) Medicaid expansion, nearly all adults with incomes below 138 percent of the federal poverty level ($16,394 per year for an individual in 2016) are now eligible for Medicaid. As of February 2016, 31 states and the District of Columbia had adopted this expansion; the remaining 19 states had not. Among low-income individuals, the uninsured rate remains high, especially in states that have not implemented the Affordable Care Act’s Medicaid expansion. Medicaid eligibility for parents in non-expansion states is capped at 44 percent of the federal poverty level (FPL), and adults without dependent children — with the exception of pregnant women and people with disabilities — are not covered by Medicaid at any level of poverty. Non-expansion states are home to an estimated 2.9 million persons with incomes below 100 percent of the federal poverty level (FPL) who are unable to qualify for subsidies in the Marketplace.
Medicaid dental benefits for adults
States have considerable discretion in defining Medicaid adult dental benefits because these services are optional, not mandatory, under federal Medicaid law. For adults who qualify for Medicaid under pre-ACA law, as well as for people newly eligible for Medicaid under the ACA expansion, adult dental coverage are a state option available. As part of the Medicaid expansion, states are required to provide Medicaid expansion individuals alternative benefit plans (ABPs) based on one of four “benchmark” alternatives, including one option approved by the HHS Secretary. EHBs created by the ACA have to be included in all ABP plans. 13 The EHBs cover dental care for children, but not for adults. There are a number of ways in which states have complied with the EHB standards by using the Secretary-approved coverage option. However, dental coverage for expansion adults is identical to that for standard Medicaid adults in all 31 states and DC that have enacted the Medicaid expansion. Montana and North Dakota are the two outliers. Montana provides limited dental benefits for its traditional Medicaid adult population, but none for Medicaid expansion adults; North Dakota provides extensive dental benefits for traditional Medicaid adults, but none for expansion adults.
Medicaid dental benefits are currently available in 46 states and the District of Columbia (Figure 2 and Appendix). Although commercial dental plans often set a maximum per-person expenditure for adult dental insurance, many state Medicaid programs place caps on the number of specific services they will cover, much like they do. Medicaid dental coverage for adults varies greatly from state to state. As of February 2016, 15 states provided extensive adult dental benefits, defined as a comprehensive mix of services including more than 100 diagnostic, preventive, and minor and major restorative procedures, with a per-person annual expenditure cap of at least $1,000. Dental benefits were available in 19 states with a $1,000-a-year limits on per-person costs for procedures involving less than 100 patients. Dental care for pain relief or emergency care for injuries, trauma, or extractions was covered in all but of the states that had adult dental benefits at all Four states provided no dental benefits at all. The expense of dental care can be prohibitive even in states that give some dental benefits to Medicaid participants, making it difficult or impossible for them to get it.
SLMB income & resource limits in 2022:
Individual monthly income limit*
$1,379
Married couple monthly income limit*
$1,851
*Limits are slightly higher in Alaska and Hawaii. Even if your income is higher than the restrictions listed, you may be eligible for assistance if you work.
Individual resource limit
$8,400
The married couple’s resource limit
$12,600
The program helps pay for:
Qualifying Individual (QI) Program
The QI Program is a state program that assists those with low income and resources in paying their Part B premiums. Every year, you must apply for QI.
benefits
. QI applications are processed on a first-come, first-served basis, with persons who received QI benefits the previous year receiving preference. (If you qualify for Medicaid, you will not be eligible for QI benefits.)
QI income & resource limits in 2022:
Individual monthly income limit*
$1,549
Married couple monthly income limit*
$2,080
*Limits are slightly higher in Alaska and Hawaii. Even if your income is higher than the restrictions listed, you may be eligible for assistance if you work.
Individual resource limit
$8,400
The married couple’s resource limit
$12,600
The program helps pay for:
Part B premiums only
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI program assists with the payment of the Part A premium. If all of the following apply to you, you may be eligible:
You have a disability.
You’re working.
Because you returned to work, you lost your Social Security disability benefits and premium-free Part A.
QDWI income & resource limits in 2022:
Individual monthly income limit*
$4,615
Married couple monthly income limit*
$6,189
*Limits are slightly higher in Alaska and Hawaii. Even if your income is higher than the restrictions listed, you may be eligible for assistance if you work.
Individual resource limit
$4,000
The married couple’s resource limit
$6,000
The program helps pay for:
Only Part A premiums
You automatically qualify for Extra Help paying for Medicare medication coverage if you qualify for the QMB, SLMB, or QI programs.
These figures may rise year after year. You should still apply if your income and resources are slightly higher.
What items are included in the Medicare Savings Program resource limits?
Countable resources include:
Money in a checking or savings account
Stocks
Bonds
Countable resources don’t include:
Your home
One car
Burial plot
Up to $1,500 for burial expenses if you have put that money aside
Furniture
Other household and personal items
How do I apply for Medicare Savings Programs?
If you answered yes to any of these three questions, contact your state’s Medicaid program to check if you qualify for a Medicare Savings Program: Do you have, or are you eligible for, Part A?
Is your income expected to be at or below the income restrictions for any of the programs listed above in 2022?
Do you have restricted resources that fall below the aforementioned thresholds?
Even if your income or resources are higher than the thresholds listed here, it’s crucial to call or fill out an application if you think you might qualify for savings.
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FAQ
what is medicare savings program illinois
The Medicare Savings Program (MSP) is a state-run Medicaid programme that can assist Medicare beneficiaries (elderly or disabled) in paying premiums, deductibles, and coinsurance.
What is the income limit for Medicare in Illinois 2021?
If you are single, your monthly income limit is $1,063; if you are married, your monthly income limit is $1,437. Asset limits: If you’re single, you can have $2,000 in assets and if you’re married, you can have $3,000 in assets. 4 October 2020
Who is eligible for QMB?
You must fulfill the following income requirements to be eligible for QMB benefits, which can also be found on the Medicare Savings Programs page: The individual income limit is $1,060 per month. The monthly income limit for a married couple is $1,430. $7,730 is the individual resource limit.
How do I get my Medicare money back?
If you believe you are owed a refund on a Medicare premium, call 1-800-MEDICARE (1-800-633-4227). As one of the plan’s features, certain Medicare Advantage (Medicare Part C) plans refund participants for their Medicare Part B premium. Medicare buy-back plans are another term for these arrangements.
What is the income limit for extra help in 2021?
Your yearly income must be under $20,385 for an individual and $27,465 for a married couple living together to qualify for Extra Help.
What does QMB mean on Medicare?
Medicare providers aren’t authorized to bill you for treatments and commodities covered by Medicare, including deductibles, coinsurance, and copayments if you’re one of the 7.5 million people in the Qualified Medicare Beneficiary (QMB) Program. It is illegal for a provider to demand payment.
