Since the inception of the program, some 50 years ago, Medicare has excluded coverage for dental, vision and hearing services. The program has directly contributed to sharp declines in mortality and longer life expectancy for those aged 65 and older. Today, however, given the linkage between increased costs and poorer overall health and disorders related to these three conditions, policy experts are rethinking how Medicare, a single-payer, national social insurance program administered by the US federal government, could begin covering dental, vision and hearing services for adults aged 65 and older.

In its’ 50-year history, some public health researchers argue, Medicare has demonstrated that it is a dynamic and effective program, meeting the changing demographic and health security needs of older Americans.  Starting in 1966, Medicare provided only hospital and outpatient coverage through Medicare Part A and B, and only to people 65 and older.  In 1972, coverage was added for individuals with disabilities and end-stage renal disease.  Starting in 1982, Medicare provided coverage for hospice care, a prescription drug benefit was added in 2003 and mental health benefits were significantly improved in 2008.  

Most recently, in 2010 the Affordable Care Act (i.e., Obamacare) included many Medicare improvements to promote better health and reduce seniors’ out-of-pocket costs.

 

Could Medicare Cover Hearing Services?

 

Now, these same healthcare policy experts say Medicare needs to be responsibly expanded again to improve the overall quality of life for seniors, particularly those in lower income brackets. In a June 29 article published online by JAMA, health policy researchers made a case for the inclusion of dental, vision and hearing services by Medicare in order to improve health outcomes for older adults. Currently, about 50 million Americans aged 65 and older receive Medicare. The majority of these Medicare beneficiaries, especially those of lower income status, routinely skip dental, vision and hearing services.

Amber Willink, PhD

According to Amber Willink of the Bloomberg School of Public Health at Johns Hopkins University and her two co-authors, the low uptake of hearing services by older Americans on Medicare is supported by a 2012 Medicare Current Beneficiary Survey that indicated 75% of Medicare beneficiaries reported having a lot of trouble with their hearing, and 84% of that group reported that they did not have a hearing aid. Further, the authors cited a 2017 report that found Medicare beneficiaries spent 4% of their incomes on dental, vision and hearing services; with the average spend on hearing services being $1338. Since these services are mainly an out-of-pocket expense, many Medicare recipients are likely to forgo these services and cope with the negative consequences associated with them.

 

Expansion of dental, hearing and vision services under Medicare could be modeled, argue Willink and her colleagues, as a voluntary supplemental benefit similar to the Medicare Part D Prescription Drug benefit through the application of a modest ($150) deductible, and 20% cost sharing on necessary services up to a maximum of $1500 per year for each individual enrolled in the program.

 

These expanded services, according to the authors, could be paid for by a monthly premium of $25 per enrolled beneficiary and would cost US taxpayers approximately $1.05 billion per year with 9 million older Americans projected to enroll in a program that expands care for dental, vision and hearing.  Since hearing loss affects more than 60% of those over 70 years old, and almost 80% of those over 80 years old, expanding hearing services to some 9 million Medicare beneficiaries could be a boon for hearing care professionals.  

In exchange, Medicare members who enroll in this type of program would receive one preventive dental exam and cleaning per year, an annual eye exam and “access to more affordable hearing aids.” The authors go on to say that the cost of hearing aids could be reduced through a competitive bidding process in which the benefit would cover the lowest bid for a high-quality device that a beneficiary could obtain every three years. The June 29 article makes no mention of hearing services such as an audiological assessment in their proposal for covered Medicare benefits. Another recent JAMA report indicated that Medicare may likely be able to cover hearing devices at one-third of the current average cost.

 

How Low Can You Go?

 

Healthcare policy experts writing in this recent June 29 JAMA article suggest that expanding Medicare to cover vision, dental and hearing services would make important health care services available to more older Americans.  This change in Medicare policy would go a long way toward avoiding depression and social isolation, as well as preventing health care costs due to accidents, falls, cognitive impairments, an increase in chronic conditions and oral cancer.

Given the current cost structure of hearing devices, however, expanding these services to Medicare recipients is likely too expensive and not palatable to legislators or voters. Would hearing care professionals and their manufacturing partners be willing to substantially reduce their costs through a competitive bidding process to gain Medicare patients remains an open question.

 

*featured image courtesy wikimediacommons

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