Expanded Medicare Coverage of Dental, Mental Health, Substance Use, and Caregiver Services on the Horizon

The Biden-Harris administration has finalized the 2024 Physician Fee Schedule rule, an annual update to Part B provider payments and related policies. Starting next year, this rule will extend the coverage of medically necessary dental treatment, expand access to some mental health and substance use disorder providers, and help family caregivers access training and support.

Medicare Part B currently pays for dental treatment under narrow circumstances—when it is linked to the clinical success of another covered service. That is, when the dental service is integral to “medically necessary” services needed to treat a beneficiary’s primary medical condition. For example, many individuals need dental care because oral conditions or infections may otherwise impede the safety of or access to Medicare-covered surgeries.

These situations that have long been too-narrowly defined, curtailing access to important oral health treatments. Over the past several years, the Centers for Medicare & Medicaid Services (CMS) has worked to correct this by clarifying that medically necessary dental services are appropriate in a wider range of circumstances, such as prior to organ transplants, cardiac valve replacements, and head and neck cancer treatments. This year’s final rule codifies some of those modernizations and ensures dental care will also be available to people undergoing certain cancer treatments, including chemotherapy and some radiation and cell therapies. Critically, the administration also continued its openness to considering additional instances in which it should clarify the availability of medically necessary dental care.

The final rule also implements recent legislation allowing Part B to reimburse more behavioral health care providers and care settings—marriage and family therapists, mental health counselors, and intensive outpatient programs—for the mental health services and substances use disorder treatments they deliver. This is welcome news, as it will expand access to care for people with behavioral health conditions, many of whom can struggle to find Medicare-covered providers.

To further improve access to care, the rule makes changes to better support family caregivers. Beginning next year, Medicare will reimburse providers for training certain family caregivers to support their loved ones, creating incentives to integrate caregivers into the broader care team. These provisions are an important step in recognizing the value of family caregiving, an often-overlooked segment of our health care system.

Medicare Rights applauds each of these improvements and looks forward to building upon them to further promote beneficiary health and well-being.

Read the 2024 Physician Fee Schedule final rule and fact sheet.

Read our comments on the proposed rule, focusing on the dental and behavioral health provisions.

Read a national sign-on letter led by AARP, focusing on the caregiver provisions.

Read more about medically necessary dental care.

Read the sign-on letter supporting caregiver training.