Medicare Coverage for Dental, Vision, and Hearing Faces Roadblock

Traditional Medicare has historically excluded coverage for dental, vision, and hearing. While this might seem absurd—considering that over 60 million Americans are enrolled in Medicare and a majority of them are seniors—many Medicare enrollees don’t get the care they need because buying separate dental, vision, and hearing coverage is expensive. Private Medicare Advantage (MA) plans may provide these as supplemental benefits, but coverage may vary. While the Biden Administration announced plans to extend Medicare coverage for these services, that goal post might move again.

Routine Services Not Covered by Traditional Medicare, and What That Does 

Interestingly, Traditional Medicare, also called Original Medicare, does not cover the following routine services:

• Dental: While dental services when a person is in a hospital may be covered, the following routine services are not:
  • Teeth cleaning
  • X-rays
  • Fillings
  • Dental plates
  • Dentures
  • Extractions
• Vision
  • Routine eye exams
  • Prescription glasses and contact lenses

Medicare Part B (Medicare insurance) does cover the cost of corrective lenses that are needed after a cataract surgery.

• Hearing
  • Routine hearing exams are not covered. However, doctor-prescribed diagnostic hearing and balance exams are covered under Medicare Part B.
  • Hearing aids
  • Office visits to fit hearing aids

Consequences

This coverage gap within Traditional Medicare means seniors either cover the costs 100% out of pocket, gain coverage through private MA plans, or avoid seeking care. A recent analysis found that high-income Medicare beneficiaries are more likely to enroll in MA plans for dental, vision, and hearing coverage, compared to low-income beneficiaries. Many of them end up bearing a significant portion of the cost despite having coverage (65% of vision, 76% of dental, and 79% of hearing costs), simply because of the way the benefits are structured. 

According to a report by the Center for Budget and Policy Priorities (CBPP):

• Over 50% of Medicare enrollees do not have dental coverage: 25% turn to MA for coverage and an additional 19% get it through Medicaid or private plans. 
• 75% of MA enrollees have some hearing coverage. However, most plans cover only a small portion of the cost of hearing aids, which are quite expensive. So the remaining cost burden falls on the enrollee. 
• Most MA enrollees have access to eye exams or glasses

If seniors skip necessary care because it is expensive, it can lead to complicated health issues such as falls or serious infections, with a long-term impact on overall health and quality of life. Consequently, this can lead to complications that may require more expensive treatments or emergency room visits.

Based on their research, CBPP recommended that Congress should provide dental, vision, hearing services to all individuals enrolled in Medicare and Medicaid, with Medicare covering these services under Part B.

Will Traditional Medicare Cover Dental, Vision, and Hearing?

In the summer of this year, the Biden Administration partnered with Senate Democrats to announce a budget framework for 2022 that includes expanding Medicare coverage to include dental, vision, and hearing. However, during a townhall meeting hosted by CNN, President Biden seemed skeptical about this proposal, saying that it would be a “reach” to include them within the provisions of his Administration’s economic agenda. Citing Senator Joe Manchin’s (D-WV) opposition to this coverage provision, the President said that other ideas, such as providing dental vouchers, have been discussed.

As we see it, this policy change continues to face challenges.

Resource:

Slides from our Webinar, “Getting the Most Out of Medicare“, 2020

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