Medicare Doesn’t Cover Hearing, Vision and Dental Services. Could Congress Change That?

At least 17 U.S. Senators and 150 Representatives have formally called on the Biden administration to include vision, hearing and dental care in plans to expand Medicare coverage. Federal law currently bars Medicare from covering basic services in these areas, including eyeglasses and eye exams, hearing aids and dental care.

“Back when Medicare was crafted in the 1960s, it was really a piece of social welfare legislation to cover catastrophic illnesses,” said Barbara Kelley, the executive director of the Hearing Loss Association of America, to RetireGuide.

Most private health insurance at the time covered hospitalization and visits to doctors’ offices. Hearing, vision and dental services weren’t considered critical at the time and items like hearing aids, eyeglasses, dental work were deliberately left out of Medicare when Congress created it in 1965.

These services were considered normal aging problems at the time, but medical research since the 1960s has shown they are intertwined with other, more serious health conditions. According to Kelley, hearing loss, for example, has been linked to falls, isolation, depression, anxiety, and even dementia.

“If you talk to family medicine or primary care doctors, they will tell you with certainty that ignoring medical issues related to dental, vision and hearing often devolves into far more serious medical problems for people — especially seniors — that cost more to treat and are harder to remedy,” said Senate Majority Leader Chuck Schumer (D-N.Y.) during a June 20 news conference.

Source: Associated Press and Congressional Budget Office

Advocacy groups have also called for varying forms of Medicare expansion, but many stop short of covering all dental, hearing or vision care options.

Any expansion plan would be part of a broader, $1.8 trillion American Families Plan from the Biden administration. And the White House plan faces opposition over its cost.

In the meantime, there are ways people on Medicare can reduce their hearing, dental, and vision care costs.

Check Your Medicare Advantage Plan for Coverage

Many people may not realize they already have coverage for hearing, vision and dental care through their Medicare Advantage plan.

“I was shocked to find out about people not knowing their Medicare Advantage plan covered hearing aids,” Kelley said.

Medicare Advantage plans are private policies you can purchase to replace your federal Medicare Part A and Part B coverage. Medicare Advantage plans are required by law to cover everything Original Medicare covers, but they can offer additional benefits that Part A and Part B do not provide. These typically include vision, hearing and dental benefits.

“For Medicare beneficiaries enrolled in Medicare Advantage plans, beneficiaries already have access to vision care services,” said Dr. David Glasser, the secretary for federal affairs at the American Academy of Ophthalmology, to RetireGuide.

If you have a Medicare Advantage plan, you should check with the company that administers it to see what services are covered.

Medigap plans – also called Medicare Supplement insurance – do not cover hearing, vision and dental costs. These supplement your Original Medicare from the federal government. Medigap only helps you pay out-of-pocket costs for things Original Medicare covers.

Make sure you know whether you have Medicare Advantage or Medicare Supplement insurance.

Other Resources To Consider

If you qualify for other state and federal benefits, these may cover some or all of your dental, hearing or vision care – even if you are on Medicare. Local civic clubs and state organizations may also be able to help with financial assistance.

Impact of Medicare Covering Hearing Aids and Services

About two-thirds of Americans 70 and older have some form of hearing loss. The Hearing Loss Association of America (HLAA) supports expanding Medicare to cover hearing aids and services – including fittings, follow-up visits, aural rehab, and other related services.

“The number one call, email or letter that we’ve gotten over the 35 years I’ve been with HLAA is, ‘I need hearing aids, I can’t afford them, and Medicare doesn’t cover them’,” said Kelley. “Expanding Medicare to cover hearing aids and services will have a big impact.”

Modern hearing aids can be complex digital devices that monitor pulse and blood pressure or alert someone if you fall. These features can drive up the price. Kelley points out that a single hearing aid can cost up to $4,000, but even a basic pair of hearing aids can run around $1,400.

“We want Medicare to cover hearing aids and services,” Kelley added. “We’re hoping that perhaps Medicare will pay for a basic device and people will have the option to top up on options they can afford.”

But the cost isn’t limited to just the hearing aids. Kelley says the device itself is usually only about a third of the cost to address hearing loss issues.

The remaining two-thirds are the related services hearing aid specialists and audiologists provide to treat your condition.

Millions on Medicare Would Benefit from Vision Coverage

Medicare doesn’t cover eyeglasses except following cataract surgery. More than 40.5 million older Americans wear glasses or contact lenses, according to a 2018 study in the Journal of the American Medical Association Ophthalmology.

Almost four million of those reported they still had problems seeing – likely needing new prescription lenses.

“Some of the cost of providing eyeglasses could potentially be offset by reductions in falls, depression, and cognitive decline in older adults,” the authors of the study wrote.

Medicare covers rehabilitation services and necessary durable medical equipment (DME) for beneficiaries with most medical conditions that reduce their ability to function physically. But that isn’t necessarily the case for vision impairment.

The American Academy of Ophthalmology (AAO) has encouraged Medicare and Congress to address what it calls “a critical gap” in Medicare coverage.

An estimated 40.5 million Medicare beneficiaries used eyeglasses for vision correction in a 2015 federal study.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142972/

“We support the concept of making vision services and eyeglasses available to Medicare beneficiaries,” Dr. Glasser said. “Low vision often results in impairment of daily activities, loss of independence, increased risk of falls and fractures and reduced quality of life and life expectancy.”

But the AAO stresses that any expansion in vision services should not divert Medicare resources away from treatment for serious, blinding eye diseases and conditions.

“We want to make sure that access to critical services and treatments for medical eye care is not compromised in the effort to expand Medicare benefits,” Dr. Glasser said.

AAO Offers Financial Aid for Eye Care for Medicare Beneficiaries

The AAO sponsors EyeCare America to promote access to critical vision care services to U.S. seniors 65 and older. Volunteer ophthalmologists in the program agree to accept whatever your private insurance pays and offer their services free of charge.

If you’re eligible, If you’re eligible, a participating ophthalmologist matches with you for a comprehensive eye exam and up to one year of eye care.

“More than 90 percent of care is provided at no out-of-pocket cost to the patient,” said Dr. Glasser.

Most Medicare Beneficiaries Do Not Have Dental Coverage

Medicare does not cover dental care unless it is related to another medically necessary procedure. Medicare beneficiaries who want dental coverage have to find a private insurance option in most cases.

But purchasing a private dental insurance plan can still leave you with steep out-of-pocket expenses – some costing more than $1,000 a year in premiums alone.

According to the Kaiser Family Foundation, almost two-thirds of people on Medicare – about 37 million Americans – have no dental coverage.

Source: Kaiser Family Foundation

According to the American Dental Association, the cost of extracting four teeth and providing a partial upper denture was $4,800 in 2020.

Oral health care is linked to other health problems as you age. Having routine dental care can help diagnose serious health conditions including nutritional deficiencies, HIV, infections and certain types of cancer.