HR-9832-119
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sponsored by Nanette Barragán (D-CA)
What it does
This bill would add dental and oral health services to Medicare Part B for services furnished on or after January 1, 2028. Covered services would include exams, cleanings, x-rays, fillings, extractions, root canals, crowns, dentures, and emergency care. Routine preventive care would be covered as a preventive service, with limits of two cleanings and two exams per 12 months. For other dental services and dental prostheses, Medicare's payment share would start at 0% and rise 10 percentage points a year to 80%, but would be 80% from the start for people eligible for Part D low-income subsidies. Dentures would be limited to one full or partial upper and lower set every five years. The Secretary of Health and Human Services may add limits (including prior authorization), modify coverage in line with Preventive Services Task Force recommendations, and waive limits. The bill would also repeal the current Medicare exclusion of dental services. It would set the federal share at 100% of state Medicaid spending on dental cost-sharing for qualified Medicare beneficiaries, and would require at least one oral health professional on the Preventive Services Task Force.
Who benefits
Medicare beneficiaries, now roughly 65 million people, who lack dental coverage, especially low-income enrollees who would get 80% coverage from the first year. Denture wearers and people needing major dental work. Dentists and dental practices that would gain a new payer. States, which would receive full federal funding for dental cost-sharing for qualified Medicare beneficiaries. Oral health professionals, who would gain a required seat on the Task Force. Hospitals and emergency departments might see fewer dental-related visits.
Who is hurt
Federal taxpayers, who would fund a new Medicare benefit. Part B enrollees, whose premiums could rise because Part B costs are partly financed by premiums. Dentists who prefer not to participate in Medicare, or who face its payment rates, prior authorization, and paperwork. Medicare Advantage plans and supplemental dental insurers, which may face competition or have to adjust their benefits. The Department of Health and Human Services and Medicare contractors, which would bear the cost of setting up the benefit. Beneficiaries in areas with few participating dentists might see limited access. Enrollees would owe rising coinsurance during the phase-in years.
Supporters argue
Supporters argue that Medicare's exclusion of most dental care leaves millions of older and disabled Americans without coverage for care tied to nutrition, heart disease, and diabetes. They contend the phased-in payment schedule, the immediate 80% rate for low-income enrollees, and the limits on frequency and Secretary-set controls manage costs while covering a gap that private dental coverage has not closed for many retirees.
Opponents argue
Opponents argue that a new Part B benefit would add large federal spending to a program already facing trust fund pressure, and would likely raise premiums for all enrollees. They contend the broad Secretary authority to define services and limits creates cost uncertainty, and that dentist participation, payment rates, and administrative workload could limit access while targeted programs might help low-income seniors at lower cost.
Constitutional context
Congress creates this benefit under the Taxing and Spending Clause (Art. I, §8, cl. 1), a power broadly upheld for Social Security Act programs in Helvering v. Davis (1937). The Medicaid cost-sharing change is a voluntary funding increase to states, so the coercion limit in NFIB v. Sebelius (2012) is not clearly implicated. Broad authority delegated to the Secretary to define services is also relevant to agency-authority questions after Loper Bright (2024).
Checks and balances
Congress would create the benefit and the funding, while the HHS Secretary gains substantial discretion to define services, add limits, and waive them; courts review agency action, and Congress controls funding through appropriations and oversight.
Historical precedent
Medicare has excluded most dental care since its 1965 creation, and prior bills to add dental coverage were introduced but not enacted, though Medicare Advantage plans have offered supplemental dental benefits.