Medicare Dental Benefit Act of 2026

Expanded Healthcare Access: The bill would provide coverage for various dental and oral health services, including routine diagnostic and preventive care, basic services like fillings, major services like crowns, and emergency care (Section 2(b)).

Enhanced Support for Low-Income Individuals: Certain low-income individuals, specifically those who are subsidy eligible, would receive a higher payment rate of 80 percent for dental services and prostheses starting in the first year (Section 2(d)(2)(B) and Section 2(f)(2)(B)(ii)).

Improved Expertise in Preventive Services: The U.S. Preventive Services Task Force would be required to include at least one oral health professional to provide expertise (Section 4(a)).

State Financial Support: The bill increases the Federal medical assistance percentage to 100 percent for certain state expenditures related to Medicare cost-sharing for dental and oral health services (Section 3).

Delayed Full Coverage: For most individuals, the payment percentage for dental and oral health services starts at 0 percent for the first year, with a gradual increase of 10 percentage points each year until reaching 80 percent in the eighth year (Section 2(d)(2)(A)).

Service Frequency Restrictions: Coverage for certain services is limited, such as a maximum of two dental cleanings and two routine exams within a 12-month period (Section 2(d)(3)(A)).

Limitations on Dental Prostheses: There are limits on how often individuals can receive dental prostheses, specifically no more than one full upper and one full lower prosthesis every five years, and no more than one partial upper and one partial lower prosthesis every five years (Section 2(f)(3)(A)).

Potential for Additional Restrictions: The Secretary has the authority to apply additional limitations on coverage, such as requiring prior authorization (Section 2(d)(3)(B)(i)).