Medicare

Established in 1965, Medicare is the federal health insurance program that provides benefits to individuals age 65 and older and individuals with disabilities. Currently, Medicare consists of four parts:

• Part A: includes hospital visits and inpatient care
• Part B: includes outpatient and physician services, as well as some preventive services
• Part C: includes Medicare Advantage
• Part D: covers prescription drugs

Originally created to address high-cost health care, Medicare statutorily excluded hearing care, dental, and vision from coverage – exclusions the program maintains today. Medicare supplemental insurance (Medigap), which is private health insurance intended to pay for costs and services that original Medicare does not cover, generally does not extend coverage to hearing aids.  The Medicare program is expected to see significant continued growth, with approximately 10,000 baby boomers reaching the age of 65 every single day resulting in an estimated 80 million plus beneficiaries by 2030.

Medicare Advantage (or Part C) is a private health insurance offering where Medicare pays a set amount per person to the Medicare Advantage plan, with individuals responsible for any additional premiums, depending on the plan they select. Medicare Advantage plans include the benefits of original Medicare (Parts A and B) and typically offer additional benefits, such as hearing, dental, and vision. In fact, approximately 94% of Medicare Advantage plans offer some type of hearing benefit.ⁱ

Medicare covers an increasingly large part of the population as the baby boomer generation ages into the program. Currently, over 65 million Americans are enrolled in Medicare. Of that, nearly 34 million are enrolled in original Medicare and over 31 million individuals – or almost half – are opting to enroll in Medicare Advantage.ⁱⁱ Of those individuals enrolled in Medicare Advantage, more than 9 out of 10 report that they are satisfied with their coverage.ⁱⁱⁱ

Hearing Health in Congress

Healthcare is an ongoing priority in the 118^th Congress (2023-2024) and typically receives additional interest during a presidential election season. With an expected continued growth in Medicare program costs and increasing enrollment in both original Medicare and Medicare Advantage, Congress is closely scrutinizing program parameters, practices, and future solvency.

Legislation has been introduced to expand Medicare and address hearing health coverage more broadly, but movement on these proposals may be difficult in a divided Congress and with ongoing discussions around federal spending. An overview of introduced hearing health-related legislation is below.

Congress has also ramped up oversight of the Medicare Advantage program, taking steps in 2022 to streamline the prior authorization process. Congress and related agencies continue to review the marketing practices of plans, costs and sustainability of Medicare and Medicare Advantage, and the future of supplemental benefits.

Current Legislation in the 118th Congress

H.R. 33, Medicare Dental, Vision, and Hearing Benefit Act of 2023: A bill to provide for Medicare coverage of dental, vision, and hearing care. Coverage includes (1) routine dental cleanings and exams, basic and major dental services, emergency dental care, and dentures; (2) routine eye exams, eyeglasses and contact lenses; and (3) routine hearing exams, hearing aids, and exams for hearing aids. with respect to such care, the bill establishes special payment rules, limitations, and coinsurance requirements. Sponsor: Lloyd Doggett (D-TX); Cosponsors: 103 Democrats

S. 842, Medicare and Medicaid Dental, Vision, and Hearing Benefit Act: A bill to strengthen coverage for dental, vision, and hearing services under Medicare by repealing the statutory exclusion. The bill would expand Medicare coverage for routine exams and other preventive care, as well as coverage for items like dentures, eyeglasses, and hearing aids. Sponsors: Robert Casey (D-PA), Benjamin Cardin (D-MD); Cosponsors: Sherrod Brown (D-OH), Richard Blumenthal (D-CT), John Fetterman (D-PA), Peter Welch (D-VT), Jeff Merkley (D-OR)

H.R. 1326, SALT Act: A bill to modify the limitation on the deduction by individuals of certain State and local taxes and to provide coverage for hearing and vision care under the Medicare program. Sponsor: Katie Porter (D-CA); Cosponsors: Sean Casten (D-IL), Brad Sherman (D-CA), Mike Levin (D-CA)

H.R. 244, Medicare Hearing Aid Coverage Act: A bill to allow for Medicare coverage of hearing aids and related examinations. The Government Accountability Office must study programs that provide assistance for hearing aids and related examinations for individuals with hearing loss. Sponsor: Debbie Dingell (D-MI); Cosponsors: Brian Fitzpatrick (R-PA), Lloyd Doggett (D-TX), Marcy Kaptur (D-OH), Derek Kilmer (D-WA), Doris Matsui (D-CA), Janice Schakowsky (D-IL), Adam Smith (D-WA)

H.R. 2439, Ally’s Act: A bill to require coverage of hearing devices and systems (osseointegrated hearing devices, including bone anchored hearing aids and cochlear implants) in certain private health insurance plans. Sponsor: Joe Neguse (D-CO); Cosponsors: Brian Fitzpatrick (R-PA), Mike Thompson (D-CA), Paul Tonko (D-NY), Betty McCollum (D-MN), Mark Takano (D-CA), Steve Cohen (D-TN), Greg Stanton (D-AZ), Bonnie Watson Coleman (D-NJ), Judy Chu (D-CA), Angie Craig (D-MN), Jason Crow (D-CO), Chellie Pingree (D-ME), Yadira Caraveo (D-CO), Katie Porter (D-CA), Emanuel Cleaver (D-MO), Colin Allred (D-TX), Sheila Jackson Lee (D-TX), Doris Matsui (D-CA), Diana DeGette (D-CO), Brittany Pettersen (D-CO), Kevin Mullin (D-CA), Andy Kim (D-NJ), John Rutherford (R-FL), Alexandria Ocasio-Cortez (D-NY), Terri Sewell (D-AL)

S. 1135, Ally’s Act: A bill to require coverage of hearing devices and systems (osseointegrated hearing devices, including bone anchored hearing aids and cochlear implants) in certain private health insurance plans. Sponsor: Shelley Moore Capito (R-WV); Cosponsors: Elizabeth Warren (D-MA); John Hickenlooper (D-CO)

H.Res. 193, Expressing support for the goals and ideals of “World Hearing Day”: A resolution expressing support for World Hearing Day and other efforts to promote ear and hearing care. Sponsor: Mike Thompson (D-CA); Cosponsors: Brian Fitzpatrick (R-PA)

S. 2377, Medicare Audiology Access Improvement Act (MAAIA): A bill to amend the definition of “audiology services” in the Medicare statute, include audiologists as practitioners, allow direct access to audiologists, and ensure access to services at Rural Health Centers and Federally Qualified Health Centers. Sponsor: Elizabeth Warren (D-MA); Cosponsors: Rand Paul (R-KY), Chuck Grassley (R-IA), Jeanne Shaheen (D-NH), Kyrsten Sinema (I-AZ), Roger Wicker (R-MS), Sherrod Brown (D-OH), Peter Welch (D-VT), Angus King (I-ME)

S. 1655, Medicare for All Act: A bill to establish a Medicare-for-all national health insurance program. Provisions include expanding Medicare to cover dental and vision services and hearing aids and examinations under Part B. Sponsor: Bernie Sanders (I-VT); Cosponsors: Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Kirsten Gillibrand (D-NY), Martin Heinrich (D-NM), Mazie Hirono (D-HI), Ben Ray Lujan (D-NM), Edward Markey (D-MA), Jeff Merkley (D-OR), Alex Padilla (D-CA), Brian Schatz (D-HI), Elizabeth Warren (D-MA), Peter Welch (D-VT), Sheldon Whitehouse (D-RI)

Previous Legislation in the 117th Congress 

In the 117^th session of Congress (2021-2022), Congress came close to passing legislation to expand original Medicare to include hearing coverage, but the package was ultimately rejected. That proposal, part of the Build Back Better Act, would have included coverage for hearing evaluations, services, and treatment, including hearing aids. Additional proposals, many reintroductions of previous legislation, are also listed below. 

H.R. 5376, Inflation Reduction Act (previously known as the Build Back Better Act): The original House-passed version of this bill included a provision to expand Medicare coverage to hearing care, including hearing aids. The Senate removed this provision, and it was not included in the final enacted law.

H.R. 1118, Medicare Hearing Aid Coverage Act: A bill to amend title XVIII of the Social Security Act to remove the exclusion of Medicare coverage for hearing aids and examinations. This measure also requires the Government Accountability Office (GAO) to conduct a study and issue a report to Congress on programs providing assistance for hearing aids and examinations, and programs to reduce or mitigate hearing loss. 

H.R. 1106, Help Extend Auditory Relief (HEAR) Act: The HEAR ACT would amend the Social Security Act to include Medicare coverage for hearing rehabilitation, including a comprehensive audiology to determine if a hearing aid is appropriate. It would also extend Medicare Part B coverage to hearing aid devices. 

H.R. 1587, Medicare Audiologist Access and Services Act: The MAASA Act provides certain coverage of audiologist services under the Medicare program, including allowing audiologists to provide diagnostic and treatment services covered by Medicare, classifying audiologists as practitioners, and allowing for direct access to audiologists. 

H.R. 4311, Medicare Dental, Vision, and Hearing Benefit Act: This bill provides for Medicare coverage of dental, vision, and hearing care, including routine hearing exams, hearing aids, and exams for hearing aids. This measure allows for one hearing aid per ear during a 48-month period, classifies hearing aids as durable medical equipment, and includes an exclusion from competitive bidding. 

S. 1731, Medicare Audiologist Access and Services Act: The MAASA Act provides certain coverage of audiologist services under the Medicare program, including allowing audiologists to provide diagnostic and treatment services covered by Medicare, classifying audiologists as practitioners, and allowing for direct access to audiologists. 

S. 2618, Medicare and Medicaid Dental, Vision, and Hearing Benefit Act: This bill provides Medicare coverage for routine hearing exams, exams for hearing aids, and hearing aids. The bill classifies hearing aids as durable medical equipment and allows for not more than one hearing aid per ear during a 48-month period.