Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries

Abstract

Among Medicare beneficiaries, dental, vision, and hearing services could be characterized as high need, high cost, and low use. While Medicare does not cover most of these services, coverage has increased recently as a result of changes in state Medicaid programs and increased enrollment in Medicare Advantage (MA) plans, many of which offer these services as supplemental benefits. Using data from the 2016 Medicare Current Beneficiary Survey, this analysis shows that MA plans are filling an important gap in dental, vision, and hearing coverage, particularly among low-and middle-income beneficiaries. In 2016 only 21 percent of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas 62 percent of MA enrollees were in plans with a dental benefit. Among Medicare beneficiaries with coverage overall, out-of-pocket expenses still made up 70 percent of dental spending, 62 percent of vision spending, and 79 percent of hearing spending. While Medicare beneficiaries are enrolling in private coverage options, they are not getting adequate financial protection. This article examines these findings in the context of recent proposals in Congress to expand Medicare coverage of dental, vision, and hearing services.

Factors Associated With Hearing Aid Use Among Medicare Beneficiaries

“…The cost of hearing aids has been proposed as a significant barrier to hearing aid use with studies showing marked differences in hearing aid utilization by income ( Willink et al, 2020 ). The impact of the cost of hearing aids to an individual may be dampened by insurance coverage.…”

“…In our study, having hearing aid coverage was not associated with hearing aid use. This could be because hearing coverage under Medicare Advantage plans is insufficient to support the purchase of hearing aids, as beneficiaries with these plans still pay over 70% of the total spending on hearing care ( Willink et al, 2020 ). It could also be that access to care measures and health-seeking behaviors, beyond insurance coverage, may be more important in determining hearing aid use, consistent with the low prevalence of regular hearing aid use in the United Kingdom ( Aazh et al, 2015 ).…”

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

“…6,7 There is a robust and growing body of evidence that oral health is a critical component of overall health and that poor oral health may lead to negative health outcomes including the exacerbation of chronic inflammatory diseases and conditions such as diabetes, cardiovascular disease, and pulmonary disease. [8][9][10][11][12] The US Surgeon General's landmark report, Oral Health in America, reminded educators and practitioners of the fundamental fact that oral diseases and disorders present a systemic burden and that health-care providers should be "ready, willing, and able to work in collaboration to provide optimal health care for their patients." 13 Yet more than 20 years since that seminal report, and despite growing awareness of oral-systemic relationships, there is still little oral health content on non-dental professional websites and slow adoption of interprofessional practices by medical providers.…”

U.S. Policy Considerations for Telehealth Provision in Audiology

“…Medicare national coverage determinations for audiology services 45 currently number fewer than 50 and are primarily constituted of diagnostic procedures, apart from coverage of cochlear implants, osseointegrated bone-conduction hearing devices, and related programming services. It is estimated that more than 75% of hearing care costs in the United States are self-pay, 17,46 with an average out-of-pocket cost for services of $1,000 plus additional costs for hearing aids, averaging $2,000 per unit. Hearing care costs are a major access barrier for the majority of U.S. adults who could pose to benefit, considering that an out-of-pocket cost of $2,500 would constitute a catastrophic health expense for 77% adults with serious hearing difficulty.…”

“…15 Hearing loss is the fifth most common cause of years lived with a disability 16 and largely remains unaddressed as a chronic health concern by most insurers in the United States. 17,18 Prevalence of hearing loss among children is also common. Two out of every 1,000 infants are born with a hearing loss 19 and 12% of children aged 6 to 19 years have a hearing loss due to noise exposure from listening to excessively loud music through headphones.…”