Medicare Dental Benefit Act of 2026

Expanded Health Coverage: The bill adds coverage for dental and oral health services, which include routine diagnostic and preventive care, basic services like fillings and extractions, major services like root canals and dentures, and emergency dental care (Section 2(b)).

Increased Support for Low-Income Individuals: For individuals who are subsidy eligible or would be eligible for a prescription drug plan, the bill provides an immediate 80 percent applicable percentage for dental and oral health services and dental prostheses (Section 2(d)(2)(B)(ii) and Section 2(f)(2)(B)(ii)).

Enhanced Expert Guidance: The bill ensures that the Preventive Services Taskforce includes expertise from at least one oral health professional (Section 4(a)).

Delayed Full Coverage: For most people, the payment amount for dental and oral health services starts at 0 percent for the first year, with coverage increasing by 10 percentage points each year until it reaches 80 percent in the eighth year (Section 2(d)(2)(B)(i) and Section 2(f)(2)(B)(i)).

Service Limitations: The bill places specific limits on how often certain services can be used, such as restricting routine dental cleanings and routine exams to only two of each within a 12-month period (Section 2(d)(3)(A)).

Restrictions on Dental Prostheses: Coverage for dental prostheses is limited to no more than one full upper and one full lower prosthesis, or 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) and Section 2(f)(3)(B)(i)).