Medicare Dental Benefit Act of 2026

The Medicare Dental Benefit Act of 2026 aims to significantly expand Medicare coverage by establishing a new benefit for comprehensive dental and oral health services under Part B. This legislation broadly defines covered services to include routine diagnostic and preventive care, such as cleanings, exams, and x-rays, as well as basic services like fillings and extractions. It also encompasses major dental procedures, including root canals, crowns, and dentures, alongside emergency dental care and other necessary services as defined by the Secretary. The bill outlines a phased-in payment structure for most beneficiaries, starting with 0% coverage in the first year after enactment and gradually increasing by 10 percentage points annually to reach 80% coverage in the eighth year. Crucially, for low-income individuals who are subsidy-eligible, the legislation provides an immediate 80% coverage from the first year. The Secretary of Health and Human Services is granted authority to implement reasonable limitations, such as frequency limits for routine cleanings and exams (two per 12-month period), and to modify coverage based on recommendations from the U.S. Preventive Services Task Force. Additionally, the bill explicitly includes dental prostheses within Medicare coverage, subject to similar phased-in payment schedules and frequency limitations, such as one full set or one partial set every five years. It repeals the existing statutory exclusion of dental services from Medicare and increases the Federal Medical Assistance Percentage (FMAP) to 100% for states' expenditures on Medicare cost-sharing for dental services provided to qualified low-income beneficiaries. These amendments, including the requirement for at least one oral health professional on the U.S. Preventive Services Task Force, are set to take effect for services furnished on or after January 1, 2028.