Did you know that hearing services and hearing aids have been statutorily excluded from original Medicare since the program was created in 1965? Considering that one in three individuals between the ages of 65 and 74 have hearing loss, and approximately half of those over the age of 75, health coverage programs for older adults are focusing more on offering expanded benefits – including through congressional efforts to expand original Medicare.
Original Medicare
Medicare Parts A and B, or Original Medicare, provide hospital, outpatient, and physician health coverage to beneficiaries 65 years of age and over. It currently enrolls over 62 million individuals and continues to grow as approximately 10,000 Americans turn 65 every day, with enrollment expected to reach 80 million by 2030.
As signed into law in 1965, Medicare excluded what were deemed to be “routine” services, including hearing, vision, and dental, and focused instead on high-cost healthcare. In subsequent years, the Medicare program made adjustments to cover certain hearing services and treatments, such as cochlear implants and osseointegrated (bone-anchored) implants for those who meet specific criteria. Medicare also provides coverage for diagnostic hearing and balance exams. However, that coverage does not extend to hearing evaluations for the purpose of obtaining a hearing aid, nor does it cover hearing aids or services related to hearing aids.
Medicare Advantage
Fast forward thirty years to 1997, when legislation establishing Medicare Advantage (originally called the “Medicare+Choice” program) was signed into law. Medicare Advantage is growing in popularity, with over 24 million individuals (over 42% of Medicare beneficiaries) opting to enroll in a Medicare Advantage plan. You may have seen the many Medicare Advantage commercials airing on television featuring athletes or celebrities touting the extra benefits offered under most Medicare Advantage plans. These plans are privately managed health insurance that include the benefits of Medicare Parts A and B with some extra benefits that may include hearing, dental, vision, and wellness coverage. In fact, nearly 90% of Medicare Advantage plans in 2021 offer hearing aid benefits.
Medicare Expansion
Now fast forward another twenty-four years to present day. In 2021, the idea of Medicare expansion to hearing, dental, and vision benefits is more real than it has ever been before. Building on momentum from the previous Congress, when House Democrats advanced legislation expanding Medicare using drug pricing reform to pay for it, Medicare expansion is once again in the limelight.
Prior to adjourning for the August recess, the U.S. Senate passed a budget resolution to unlock the reconciliation process to pass significant reforms – including healthcare – by a simple majority vote. Under reconciliation, the House and Senate are expected to consider expanding Medicare coverage to hearing, dental, and vision benefits. What form these benefits might take has yet to be determined, but there are multiple pieces of legislation that have been introduced this Congress, as well as H.R. 3 from the previous session of Congress, that speak to the strong interest of Members of Congress in expanding Medicare to hearing services and hearing aids.
Hearing health is essential. It is crucial that policymakers recognize the importance of getting Medicare expansion right to support meaningful access to hearing health services and treatment (including hearing aids) and support continued innovation in hearing health.
You can learn more about legislation related to Medicare coverage of hearing health that has been introduced so far in the current Congress here.
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