Nearly 54 years ago Medicare – one of our nation’s most popular and successful programs – was signed into law by President Lyndon Johnson. Since then, Medicare has helped lift generations of Americans out of poverty. Before the enactment of Medicare in 1965, only 50 percent of seniors had health insurance and 35 percent lived in poverty. That was a time when even a minor illness or injury could bankrupt older Americans and their families. Today nearly 60 million Americans are receiving guaranteed health care benefits through the Medicare program regardless of their medical condition or income. This includes over 51 million Americans age 65 and above and almost 9 million Americans receiving Social Security disability insurance benefits. By the time the last of the baby boomers reaches age 65, it is expected that close to 80 million people will be covered through Medicare. Together with Social Security and Medicaid, Medicare forms the bedrock of economic and health security for today’s seniors and individuals who are disabled.
Coverage Gaps and the Burden of Out-of-Pocket Health Care Costs
Medicare goes a long way in preventing poverty and promoting greater access to health care however, Medicare coverage is not comprehensive. In addition to cost-sharing – for premiums, deductibles and coinsurance – Medicare beneficiaries must pay out of pocket for gaps in Medicare coverage. Older Americans on modest, fixed incomes often cannot afford to pay for these services, which include dental, vision and hearing care as well as long-term services and supports.
While Medicare and Social Security greatly lowered the percent of older adults living in absolute poverty, many live on extremely modest incomes that rely heavily on Social Security. More than half of all Medicare beneficiaries have incomes of less than $2,200 a month. And many working age adults who become disabled, and can no longer work, are on Social Security Disability, which pays on average less than $1400 a month.
Expanding Medicare Benefits
In its over 50-year history, Medicare has demonstrated that it is a dynamic 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. And in 2010 the Affordable Care Act included many Medicare improvements to promote better health and reduce seniors’ out-of-pocket costs.
Adding Dental, Vision and Hearing Coverage to Medicare
Since its implementation in 1965, Medicare has excluded coverage for hearing aids and related audiology services, routine dental care and routine eye exams and eyeglasses, despite the large numbers of older Americans who need such items and services.
Hearing loss affects more than 40% of people over 60 years old, more than 60% of those over 70 years old, and almost 80% of those over 80 years old. Currently only 1 in 5 Americans diagnosed with hearing issues uses a hearing aid, and the vast majority of those who could benefit from one cite financial barriers to obtaining them. Costs for a pair of hearing devices can range from $1,000 – $6,000. It is increasingly well-documented that untreated hearing loss often leads to a variety of serious health problems and injuries, including the higher risk of dementia and falls.
Medicare does not cover routine eye exams or eyeglasses, which can range in cost from $50 to $300 or more for an exam. The average cost for a pair of prescription glasses is $196. Yet individuals older than age 70 account for approximately 80% of the 2.8 million Americans with low vision (defined as vision loss, other than blindness, not correctable with refraction, medication or surgery). Sensory impairments, such as vision loss, not only diminish quality of life but increase the risk for costly health outcomes such as disability, depression, cognitive impairment and dementia.
Lack of affordable dental coverage options, provider shortages, and lack of preventive programs in communities across the country are creating serious hardships for older adults. Lack of dental insurance is a major access barrier to dental care for older adults – nearly 70% of older Americans currently have no form of dental insurance. Data shows that neglect of oral health may result in the deterioration of overall physical health, and lack of access to even routine dental exams and cleanings can exacerbate serious and complicated overall health problems that increase with age.
Expanding Medicare to cover vision, dental and hearing services would make important health care services available to beneficiaries. This 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. Now is the time we should be investing in and expanding Medicare to ensure our growing elderly population remains as healthy as possible.
National Committee Position
The National Committee’s legislative agenda supports or endorses many proposals to improve Medicare including expanding Medicare benefits to cover vision, dental and hearing health services, which are important for healthy aging and are often unaffordable for beneficiaries. Medicare benefits must be expanded, not cut, so that older Americans do not have to choose between paying for health care, food or utilities.
The National Committee to Preserve Social Security and Medicare supports the following legislative proposals that would expand Medicare benefits and improve the lives of millions of beneficiaries by providing coverage for dental, vision and hearing care.
- H.R. 576, the “Seniors have Eyes, Ears, and Teeth Act,” a bill introduced by Representative Lucille Roybal-Allard to amend Medicare to include eyeglasses, hearing aids, and dental care.
- P.L. 115-52, the “Over-the-Counter Hearing Aid Act of 2017,” legislation introduced by Senator Elizabeth Warren and Representative Joseph P. Kennedy, III, which would provide access to more affordable hearing aids for adults with mild to moderate hearing loss. This legislation was included in the FDA Reauthorization Act of 2017 and signed into law by the President on August 18, 2017.
- H.R. 1393, the “Medicare Dental, Vision, and Hearing Benefit Act of 2017,” legislation introduced by Representative Lloyd Doggett to provide for Medicare coverage of dental, vision, and hearing care.
- H.R. 1518, the “Medicare Hearing Aid Coverage Act of 2017,” legislation introduced by Representative Debbie Dingell to require Medicare to cover hearing examinations and hearing aids.
- S. 22, the “Medicare Dental Benefit Act of 2019,” a bill introduced by Senator Ben Cardin to provide coverage for dental services under Medicare Part D.
The National Committee also supports many recommendations that are included in Hearing Health Care for Adults, which was recently released by The National Academies of Sciences, Engineering and Medicine, Health and Medicine Division. Included in a long list of recommendations, the report states that the Centers for Medicare & Medicaid Services (CMS) should:
- Evaluate options, including possible statutory or regulatory changes, in order to provide coverage so that treating hearing loss (e.g., assessments, services, and technologies, including hearing aids) is affordable for Medicare beneficiaries; and
- Examine pathways for enhancing access to assessment for and delivery of auditory rehabilitation services for Medicare beneficiaries, including reimbursement to audiologists for these services. (Recommendation 9)
The report also recommends that hearing health should be promoted in regular medical and wellness visits (including the Medicare Annual Wellness Visit). (Recommendation 6)
Conclusion
Since 1965, Congress has gradually erased some of Medicare’s coverage gaps, but more must be done to make benefits comprehensive and health care delivery more efficient without compromising the quality or accessibility of care. Now is the time to expand benefits so that Medicare provides comprehensive and affordable health care coverage. Providing access to dental, vision and hearing services would go a long way toward helping older adults remain healthy, productive and as independent as possible in their homes and communities, which is what we want for ourselves and our family members.