The growing elderly population (≥65 years) imposes great challenges to oral health delivery systems. In the USA, the elderly continue to exhibit a high prevalence of chronic oral disorders. Further, poor dental access has long remained a concern and a barrier toward oral health improvement. Lack of dental insurance is a prominent contributor to the access problem. The main reason for the lack of dental insurance is the loss of employer benefits after retirement and the current transition to a national insurance program (Medicare) with insignificant dental benefits. Dental care needs to be established earlier in life through an appropriate model of care that considers the level of dependency of the elderly. The goals of dental treatment for the elderly are different from those for any other age group, and there is an increased need for the provision of dental care in regions with large elderly populations. This paper provides an overview of the challenges imposed on the health care delivery system in the USA with regard to the provision of oral health care to older adults and discusses consideration for future improvement.