Are dental, vision and hearing care covered by Medicare?

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Dental, vision and hearing benefits could be added to traditional medicare in the future under a hotly contested bill Democrats hope to pass Congress.

Dental, vision and hearing benefits could be added to traditional medicare in the future under a hotly contested bill Democrats hope to pass Congress.

Personnel file, 2005

Dental, vision and hearing benefits could be added to traditional medicare in the future under a hotly contested bill Democrats hope to pass Congress.

If passed, it would mark the first major expansion of the popular social agenda since 2003, when President George W. Bush signed the Medicare Modernization Act that added Part D, insurance. prescription drugs.

Health care advocates and the elderly strongly support the expansion, stressing the need for comprehensive coverage for the growing population 65 and over. By 2030, all baby boomers will be over 65, according to the Census Bureau.

In fact, by 2034 there will be 77 million people in the United States aged 65 and over, compared to 76.5 million under the age of 18, the first time in U.S. history that older people should outnumber children, Census Bureau projects.

“It does not make sense to exclude these [dental, vision and hearing benefits]Says Jeff Johnson, state director of AARP Florida. “This is an opportunity to fill gaps in Medicare coverage that are critical to the health and well-being of older Americans.”

The AARP, representing 38 million elderly members, sent a letter to the US House Ways and Means Committee calling the current proposal a “monumental opportunity” for Congress “to invest in health and safety financial support for all Americans, which will benefit generations to come. to come.”

Medicare beneficiaries are growing rapidly

The need to add such coverage is urgent and growing, add advocates. The elderly population is increasing dramatically. It is estimated that 10,000 Americans turn 65 every day, making them eligible for Medicare. In 2000, 35.2 million Americans were eligible for Medicare. By 2020, that number had grown to 56 million. By 2030, it is expected to reach 72.8 million.

In addition, “it’s not only that there are more seniors, but also that these seniors are living longer,” says Steven G. Ullman, director of the Center for Health Management Policy at the University of Miami. . “There is real pressure on Congress to do this. The problem does not go away. “

The passage is not a slam dunk, however. These Medicare changes are part of a $ 3.5 trillion infrastructure package that has met strong opposition from Republicans. President Biden considers this part of his healthcare agenda, but adding those benefits would cost $ 358 billion over the next decade, according to the Congressional Budget Office.

Democrats hope to pay for it, at least in part, by saving money on falling drug prices. (There is a movement underway to allow Medicare to negotiate drug prices.) Additionally, these benefits could be paid for with higher beneficiary-paid premiums, if added to Medicare Part B.

This is not the first time that proponents of Medicare expansion have attempted to add at least one of these benefits to the existing government health plan. In 2019, the House passed the Elijah E. Cummings Lower Drug Costs Now Act (HR3), which sought to add dental, visual and hearing benefits to Medicare Part B. This year, nearly 80 members of the House introduced the Medicare Dental, Vision, and Hearing Benefit Act (HR 4311) to cover these benefits.

In the Senate, Majority Leader Chuck Schumer gave a directive to the Senate Finance Committee to expand Medicare “to include dental, vision and hearing benefits.”

Policy Behind Medicare Expansion

Has the political environment changed over the past two years? Tricia Neuman, executive director of the Kaiser Family Foundation’s Medicare Policy Program, thinks so, even though she refuses to predict the outcome of the proposal.

“The delay so far has been the cost to the federal government and the political will to push this through,” Neuman adds. And while details and funding may be on the table, politics have evolved. Unlike 2019, Democrats now control, albeit tightly, both houses of Congress, and President Joe Biden has campaigned on several healthcare promises.

David Lipschutz, associate director of the Center for Medicare Advocacy, says he is “cautiously optimistic. The groundswell has reached a point where policymakers realize that coverage of oral, visual and hearing health is essential. “

Few would dispute the need for better access and better coverage. Many studies have established a clear link between oral health and chronic disease, including heart disease and diabetes. Vision loss and hearing loss have also been shown to cause social isolation in older people, which negatively influences all aspects of a person’s life.

Yet because so many Medicare registrants don’t or can’t afford coverage, they end up without routine care. As a result, preventable complications lead to more expensive medical care, including emergency room visits.

Lack of dental and hearing coverage

Currently, 47% of all Medicare beneficiaries do not have dental coverage, according to a recent analysis by the Kaiser Family Foundation. Almost half have not had a dental visit in the past year, with the rate much higher among low-income recipients.

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About 47% of all Medicare beneficiaries do not have dental coverage, according to a recent analysis by the Kaiser Family Foundation. Dan Pelle TNS

The lack of hearing health benefits is also a glaring gap in traditional health insurance. According to the National Institutes of Health, about a third of people aged 65 to 74 have hearing loss, and that number reaches half for those over 75. Yet hearing aids are expensive – between $ 1,000 and $ 5,000 – and out of reach for many. Adding them as a basic Medicare benefit could help the millions who need them.

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Traditional health insurance does not provide coverage for hearing health, including hearing aids. Dental, vision and hearing benefits can be added to traditional medicare under a hotly contested bill Democrats hope to pass Congress. Maïca Getty Images

Most seniors who now have some form of dental, vision, and hearing coverage get it through Medicare Advantage plans, which are funded with government money but managed by private insurance companies. According to the KFF study, nearly 80% of those enrolled in these benefit plans have coverage for eyesight, 74% for dental care and 72% for hearing aids and exams.

Including the same offers in traditional health insurance “is a matter of fairness,” says Lipschutz. “The majority of beneficiaries are registered with traditional health insurance and therefore do not have this type of access. “

According to KFF, 34% of all Medicare beneficiaries were enrolled in Medicare Advantage plans in 2019, the rest in traditional Medicare.

In Miami-Dade, however, these percentages are reversed. Sixty-six percent of all beneficiaries were enrolled in MA plans. In contrast, only 10 percent living in Monroe County were in MA plans. This is in part due to the fact that in a large county, MA plans have a much larger supplier network.

Medicare experts aren’t ready to predict when and how Medicare will expand, but some believe it’s inevitable. “Studies show that in the long run, it’s better to pay the upfront costs and save money,” says Ullman of the University of Miami.

Even so, the additional benefits will not be immediately available. It always takes time to define the details of coverage and implementation. Medicare Part D, for example, wasn’t offered to enrollees until almost four years after the switch.

“In some ways,” says Neuman of the Kaiser Family Foundation, “this is the start of a long and difficult process.


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