- There's no guarantee that the proposal to expand Medicare's coverage will make it through the full legislative process.
- It's uncertain exactly what would be covered and to what degree, although other legislative efforts could provide some clues, including a bill that was introduced last week and another that cleared the House in 2019 but died in the Senate.
Medicare — the health insurance program relied on by most older Americans — would cover dental, vision and hearing under a budget agreement announced late Tuesday by Senate Democrats.
The proposal for expanded coverage was included as part of a plan to spend $3.5 trillion over the next decade on climate change, health care and family-service programs, all part of President Joe Biden's economic agenda. Although there's no certainty that everything in the budget blueprint will make it through the full congressional process, Medicare advocates are hopeful that coverage of the extra benefits will come to fruition.
"This would be a very big deal for the Medicare program and Medicare beneficiaries," said David Lipschutz, associate director and senior policy attorney for the Center for Medicare Advocacy.
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"If Congress adds [those] benefits, it would fill some major gaps in coverage that the program has had since its inception," Lipschutz said.
About 62.7 million individuals are enrolled in Medicare, the majority of whom are age 65 and older and rely on it as their primary health insurance. The program was created through congressional legislation in 1965 under President Lyndon Johnson and largely reflected health-coverage standards at the time, which didn't involve widespread coverage for dental, vision and hearing, Lipschutz said.
"But as the health-care system has evolved, Medicare has often been slow to catch up," he said.
Original Medicare consists of Part A (hospital coverage) and Part B (outpatient care coverage). Except for limited exceptions, there is no coverage related to dental, vision or hearing, which can lead to beneficiaries forgoing care.
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"It would be a significant improvement [to provide coverage] for people who often go without needed care because they can't afford it and for people who pay a lot for the care they need," said Tricia Neuman, executive director for the Kaiser Family Foundation's program on Medicare policy.
Some beneficiaries get limited coverage for dental, vision and hearing if they choose to get their Parts A and B benefits delivered through an Advantage Plan (Part C), which often include those extras. About 40% of beneficiaries are enrolled in Advantage Plans.
However, Lipschutz said, the extra coverage generally is not comprehensive. On the other hand, if expanded benefits — no matter how generous — were required under original Medicare, they'd become standard in an Advantage Plan.
"We'd hope this would enrich benefits for all beneficiaries," Lipschutz said.
While no specifics were released about how the expanded coverage would be funded, Biden has proposed imposing higher taxes on the rich and on corporations.
The Senate Democrats' announcement also provided scant details about proposed changes, although other efforts to expand Medicare coverage could offer some clues.
A House bill introduced last week by Rep. Lloyd Doggett, D-Texas, would include things such as dentures, preventive and emergency dental care, refractive eye exams and eyeglasses, and hearing aids and exams.
The expanded coverage also was included in a broader health-care-related bill that cleared the House in 2019 but was not taken up by the Senate. Under that proposal, beneficiaries would have chipped in the standard 20% for some dental coverage. Major treatments — i.e., bridges, crowns, root canals — would have cost more. Dentures also would have been covered, within limits. And routine eye and hearing exams, as well as hearing aids, contact lenses and eyeglasses, also would have been included.