Expanding Covered Medicare Benefits May Lower Out-of-Pocket Costs

Policymakers are looking to include dental, hearing, and vision benefits to Medicare as a part of the budget reconciliation bill, which could benefit many Medicare beneficiaries who go without this care due to high out-of-pocket costs, according to a Kaiser Family Foundation brief.

The survey analyzed traditional Medicare and Medicare Advantage beneficiaries’ self-reported data from the 2018 and 2019 Medicare Current Beneficiary Survey to understand how often these consumers are utilizing dental, hearing, and vision services and the cost barriers they face.

Nearly half of all Medicare beneficiaries (44 percent) reported having difficulty hearing and over one in three (35 percent) reported difficulty with seeing in 2019. More than 80 percent of beneficiaries reported that they wear glasses or contacts and 14 percent use hearing aids.

In 2018, more than half of Medicare beneficiaries (53 percent) reported using dental services in the past year, compared to the 35 percent and 8 percent who used vision and hearing services, respectively.

Some beneficiaries neglected to seek care or reported paying high out-of-pocket costs in order to access these benefits. The average out-of-pocket spending for hearing care in 2018 was $914. Dental care followed close behind with an average of $874.

However, the distribution for this spending is uneven, the brief noted. A small group of beneficiaries incurred the highest out-of-pocket costs, likely due to the high costs of dental procedures like implants or hearing aid equipment.

Around 9.5 million Medicare beneficiaries reported that at some point in 2019 they could not receive dental, vision, or hearing care. Beneficiaries who were most likely to report difficulty receiving care included those who were younger than 65 with long-term disabilities, enrolled in Medicare and Medicaid, living on low incomes, or who identified as Black or Hispanic.

Many of the beneficiaries who could not access care reported that cost was a major barrier. Three out of four cited costs as a barrier to hearing services, 71 percent for dental services, and 66 percent for vision services.

Medicare Advantage members typically have health plans that offer dental, hearing, and vision coverage, but the different variations can also lead to high costs and gaps in care.

Medicare Advantage beneficiaries spent less on out-of-pocket costs for the three services in 2018, compared to traditional Medicare beneficiaries.

The majority of Medicare Advantage beneficiaries (94 percent) have a plan that offers access to dental coverage. Many enrollees have an annual dollar limit for dental coverage, the average limit being $1,300 in 2021.

Similarly, 97 percent and 99 percent of Medicare Advantage beneficiaries have plans that offer access to hearing and vision coverage, respectively.

Nearly all beneficiaries who have hearing aid coverage have an average annual dollar limit of $960 or frequency limits for services. Most members can only receive one set of hearing aids per year. Enrollees often can only receive one hearing exam per year as well.

About 60 percent of beneficiaries have plans that require cost-sharing for hearing aids, which can cost up to $3,355, the brief stated.

Most vision services for Medicare Advantage beneficiaries, including eye exams and eyewear coverage, have an average annual dollar limit of $160. The majority of members are also limited to one eye exam per year and one pair of glasses per year.

Although Medicare Advantage plans offer the services that traditional Medicare lacks, these plans can still lead to high out-of-pocket costs.

“In conducting this analysis of Medicare Advantage benefits, we found that plans do not use standard language when defining their benefits and include varying levels of detail, making it challenging for consumers or researchers to compare the scope of covered benefits across plans,” the brief stated.

Adding dental, vision, and hearing coverage to Medicare may lead to increased federal spending, including $238 billion for dental and oral health care, $89 billion for hearing care, and $30.1 billion for vision care, according to the Congressional Budget Office.

However, it could also address coverage gaps and reduce the cost of care for the millions of Americans who rely on Medicare for healthcare, the researchers argued.