Medicare Dental Benefit Act of 2026

This legislation aims to significantly expand Medicare coverage by including a comprehensive range of dental and oral health services. It defines these services broadly to encompass care necessary for disease prevention, oral health promotion, restoration of oral structures, pain reduction, and emergency treatment. Covered services will include routine diagnostic and preventive care like cleanings, exams, and x-rays, as well as basic services such as fillings and extractions.

Furthermore, the bill extends coverage to major dental services, including root canals, crowns, and dentures, and explicitly removes the existing Medicare exclusion for dental prostheses. For most beneficiaries, payment for these new dental services will be phased in, starting at 0% and increasing by 10 percentage points annually to reach 80% coverage in the eighth year. However, low-income individuals who are subsidy eligible will receive immediate 80% coverage for these services.

The legislation also sets specific limitations, such as two routine cleanings and exams per 12-month period, and one full or partial set of dental prostheses every five years. The Secretary of Health and Human Services is granted authority to apply additional reasonable limitations, modify coverage based on U.S. Preventive Services Task Force recommendations, and waive frequency limits as deemed appropriate. Finally, the bill increases the Federal Medical Assistance Percentage (FMAP) to 100% for states covering Medicare dental cost-sharing for qualified low-income beneficiaries and mandates the inclusion of an oral health professional on the U.S. Preventive Services Task Force, with all provisions taking effect on January 1, 2028.