It's quite common in West Virginia, where a quarter of people 65 and older have no natural teeth, the highest rate of any state in the country, according to federal data.

Like half of Medicare enrollees nationally, Marchio has no dental insurance. Worries about the costs led her to skip regular cleanings and exams, crucial steps for preventing infections and tooth loss.

Medicare doesn't cover most dental care, but consumer advocates had hoped that would change this year after Democrats took control of the White House and Congress. President Joe Biden and progressives, led by Sen. Bernie Sanders, sought to add the benefit to a major domestic spending package, the Build Back Better Act, that Democrats are seeking to pass.

But those chances are looking slim because at least one Democratic senator -- Joe Manchin of, yes, West Virginia -- opposes adding dental and other benefits for Medicare beneficiaries. He says it will cost the federal government too much.