Expanding Medicare’s dental, vision and hearing benefits being pushed, but it’s political

Dental, vision and hearing benefits may be added to traditional Medicare in the future under a hotly contested bill Democrats are hoping to push through Congress.

If passed, this would mark the first major expansion of the popular social program since 2003, when President George W. Bush signed the Medicare Modernization Act that added Part D, the prescription drug benefit.

Healthcare and senior advocates strongly support the expansion, pointing to the necessity of having comprehensive coverage for the growing 65-and-over population. By 2030, all baby boomers will be older than 65, according to the Census Bureau.

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

“It doesn’t make sense to exclude these [dental, vision and hearing benefits],” says Jeff Johnson, state director of AARP Florida. “It is an opportunity to close the gaps in Medicare coverage that are essential to the health and well-being of older Americans.”

AARP, representing 38 million older adult members, has sent a letter to the U.S. House Ways and Means Committee calling the current proposal “a monumental opportunity” for Congress “to invest in the health and financial security of all Americans, which will benefit generations to come.”

Medicare beneficiaries growing rapidly

The need to add such coverage is urgent and growing, advocates add. The older population is growing significantly. An estimated 10,000 Americans turn 65 every day, making them eligible for Medicare. In 2000, there were 35.2 million Americans who were Medicare eligible. In 2020, that number had jumped to 56 million. By 2030, it’s expected to reach 72.8 million.

Moreover, “it’s not just that there are more older people, but also these older people are living longer,” explains Steven G. Ullman, director of the Center for Health Management Policy at the University of Miami. “There’s real pressure on Congress to take this on. The issue is not going away.”

Passage is hardly a slam dunk, however. These Medicare changes are part of a $3.5 trillion infrastructure package that has met with strong opposition from Republicans. President Biden considers it part of his healthcare agenda, but adding these benefits would cost $358 billion over the next decade, according to the Congressional Budget Office.

Democrats hope to pay for this, at least in part, by savings from lower drug prices. (There’s a movement afoot to allow Medicare to negotiate drug prices.) In addition, these benefits could be paid with higher beneficiary-paid premiums, if added to Medicare Part B.

It’s not the first time Medicare expansion supporters have tried to add at least one of these benefits to the existing government healthcare plan. In 2019, the House passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R.3), which sought to tack on dental, vision and hearing benefits to Medicare Part B. This year, almost 80 House members introduced the Medicare Dental, Vision, and Hearing Benefit Act (H.R. 4311) to cover these benefits.

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

Politics behind Medicare expansion

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

“The hold-up so far has been the cost to the federal government and the political willpower to get this passed,” Neuman adds. And while details and funding may be up in the air, the politics has evolved. Unlike 2019, Democrats now control, albeit narrowly, both houses of Congress, and President Joe Biden campaigned on several healthcare promises.

David Lipschutz, associate director of the Center for Medicare Advocacy, says he’s “cautiously optimistic. The groundswell has reached a point where policy makers realize oral, vision and hearing health coverage is essential.”

Few argue about the need for more access and better coverage. Many studies have drawn a clear connection between oral health and chronic diseases, most notably heart disease and diabetes. Vision loss and hearing loss have also been shown to lead to social isolation among older adults, which negatively influences all parts of a person’s life.

Yet, because so many Medicare enrollees don’t have, or can’t pay for coverage, they end up doing without routine care. As a result, preventable complications result in more expensive medical care, including emergency room visits.

Lacking dental, hearing coverage

Currently, 47% of all Medicare beneficiaries don’t have dental coverage, according to a recent analysis from the Kaiser Family Foundation. Almost half did not have a dental visit within the past year, with that rate being much higher among lower income beneficiaries.

The lack of hearing health benefits is also a glaring gap in traditional Medicare. About one-third of seniors between 65 and 74 years of age have hearing loss and that number shoots up to half for those older than 75, according to the National Institutes of Health. Yet, hearing aids are expensive — between $1,000 and $5000 — and out of reach for many. Adding them as a basic Medicare benefit could help the millions who need them.

Most seniors who now have some form of dental, vision and hearing coverage get it through Medicare Advantage plans, which are funded by government money but run by private insurance companies. According to the KFF study, almost 80% of enrollees in these advantage plans have vision coverage, 74% have dental and 72% have hearing aid and exam coverage.

Including the same offerings in traditional Medicare “is a matter of fairness,” says Lipschutz. “The majority of beneficiaries are enrolled in traditional Medicare and so don’t have that kind 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, those percentages are reversed. Sixty-six percent of all beneficiaries were enrolled in MA plans. By contrast, only 10 percent living in Monroe County were in MA plans. That’s partly due to the fact that in a large county, MA plans have a much wider network of providers.

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

Even so, the added benefits won’t be immediately available. It always takes time to hammer out the details of coverage and implementation. Medicare Part D, for example, wasn’t offered to enrollees until almost four years after passage.

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