policy / research

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. Even 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.  With 10,000 baby boomers reaching the age of 65 every single day and studies showing that one in three people between the ages of 65 and 74 have hearing loss, hearing health coverage is more important than ever.

 

Medicare Advantage (or Part C) is a private health insurance offering where Medicare pays a set per person amount to the Medicare Advantage plan, with individuals responsible for any additional premiums, depending on the plan they select. Medicare Advantage includes the benefits of original Medicare (Parts A and B) and typically provides additional coverage options for hearing, dental, and vision. In fact, 97% of Medicare Advantage plans offer hearing, dental, or vision coverage and over half of Medicare Advantage plans include all three.

 

Medicare covers an increasingly large part of the population as the baby boomer generation ages into the program. As of 2019, nearly 62 million Americans are enrolled in Medicare. Of that, over 38.5 million are enrolled in original Medicare and over 23 million individuals – or one in three – are opting to enroll in Medicare Advantage and other health plans. Of those individuals enrolled in Medicare Advantage, nine out of 10 report that they are satisfied with their coverage.

 

According to a recent survey of American consumers, approximately one in three people between the ages of 65 and 74 have hearing loss and nearly half of those older than 75 have difficulty hearing. Hearing loss is associated with higher rates of isolation, depression, dementia, and falls that require hospitalization. Just mild hearing loss doubles the risk of dementia, while those with severe loss are 5 times more likely to develop dementia. Research shows a link between hearing loss and other serious health issues, yet Medicare only provides diagnostic hearing and balance exams if ordered by a physician and does not extend to hearing aids or hearing tests.

 

Hearing Health in Congress

 

Healthcare remains a priority for this Congress, with a focus on transparency in drug pricing and surprise billing. With an expected average growth of over 7% in Medicare program costs over the next decade and enrollment expected to reach 80 million individuals by 2030, Congress is also looking ahead to improving Medicare.

 

There are multiple bills that have been introduced in the current 116th Congress to expand Medicare coverage to hearing testing and devices. Certain bills solely address hearing aid coverage, while others more broadly address hearing, dental, and vision coverage. To date, the House of Representatives has acted in passing H.R. 3, a bill to lower drug costs that includes a provision expanding Medicare to include hearing benefits. The Senate, which has introduced its own drug pricing bill that does not include hearing, vision, or dental coverage, is not expected to take up H.R. 3 this year. However, these measures set the marker for future consideration of Medicare coverage.

 

Current Legislation in the 116th Congress

 

H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act, passed by the U.S. House of Representatives on December 12, 2019.

 

Introduced by House Energy and Commerce Committee Chairman Frank Pallone (D-NJ), H.R. 3 is the priority healthcare bill from the House in the 116th Congress, to lower prescription drug prices and expand Medicare to include hearing, dental, and vision benefits. Specific to coverage for hearing care and severe to profound hearing loss, H.R. 3 includes hearing aids as prosthetic devices and addresses application of the competitive acquisition process. This legislation also sets forth certain limitations, such as covering hearing aids not more than once during a 5-year period, only for hearing aids that are not over-the-counter hearing aids, and only by written order of a physician or audiologist. Although received in the Senate, this measure is not expected to be considered this Congress. Status: Passed the House of Representatives on December 12, 2019, by a bipartisan vote of 230-192. Received in the Senate on December 16, 2019.

 

H.R. 4618, Medicare Hearing Act of 2019

Introduced by Reps. Lucy McBath (D-GA) and Debbie Dingell (D-MI), this measure was largely incorporated into H.R. 3 and provides coverage for hearing aids and examinations under Medicare. As in H.R. 3, this measure includes hearing aids as prosthetic devices, establishes payment and frequency limitations, and addresses competitive acquisition.  Status: Reported (Amended) by the House Committee on Ways and Means and reported by the House Committee on Energy and Commerce. Cosponsors (6): Reps. Dingell (D-MI), Castor (D-FL), Cuellar (D-TX), Norton (D-DC), Brian Higgins (D-NY), Welch (D-VT).

 

H.R. 1518, Medicare Hearing Aid Coverage Act of 2019

Introduced by Rep. Debbie Dingell (D-MI), this bipartisan bill amends the Medicare title of the Social Security Act to include 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. Status: Referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. Cosponsors (10): Reps. Kilmer (D-WA), Kathleen Rice (D-NY), Schakowsky (D-IL), McCollum (D-MN), Kaptur (D-OH), Matsui (D-CA), DeLauro (D-CT), Lofgren (D-CA), Doggett (D-TX), Fitzpatrick (R-PA).

 

H.R. 4056, Medicare Audiologist and Services Act

A bipartisan bill introduced by Rep. Tom Rice (R-SC), this measure includes Medicare coverage of and access to audiologist services and classifies audiologists as practitioners. Many provisions of this bill were included in the amended version of H.R. 4618, the Medicare Hearing Act, as passed by the House Committee on Ways and Means. Status: Referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. Cosponsors (61): Cartwright (D-PA), Meadows (R-NC), Norman (R-SC), Mike Kelly (R-PA), Schakowsky (D-IL), Schneider (D-IL), Kuster (D-NH), Bilirakis (R-FL), Blunt Rochester (D-DE), Rodney Davis (R-IL), Shalala (D-FL), Grijalva (D-AZ), Khanna (D-CA), Cohen (D-TN), Pappas (D-NH), Chu (D-CA), Simpson (R-ID), Ruppersberger (D-MD), Massie (R-KY), Sewell (D-AL), Kildee (D-MI), Glenn Thompson (R-PA), Foster (D-IL), McKinley (R-WV), Smucker (R-PA), Reschenthaler (R-PA), Soto (D-FL), Lipinski (D-IL), Butterfield (D-NC), Stevens (D-MI), Trone (D-MD), Underwood (D-IL), McCollum (D-MN), Craig (D-MN), Abraham (R-LA), Fitzpatrick (R-PA), Ryan (D-OH), Gosar (R-AZ), Max Rose (D-NY), Doyle (D-PA), O’Halleran (D-AZ), Hollingsworth (R-IN), Cole (R-OK), Cisneros (D-CA), McBath (D-GA), Webster (R-FL), Hastings (D-FL), Amodei (R-NV), Young (R-AK), Welch (D-VT), Lowey (D-NY), Sherman (D-CA), Yarmuth (D-KY), Neguse (D-CO), Dean (D-PA), Gottheimer (D-NJ), Fortenberry (R-NE), Himes (D-CT), Susan Davis (D-CA), McGovern (D-MA), Horn (D-OK).

 

S. 2446, Medicare Audiologist Access and Services Act

The Senate companion bill to H.R. 4056, this bipartisan bill was introduced by Sens. Elizabeth Warren (D-MA) and Rand Paul (R-KY), and includes access to audiologist services under Medicare. Status: Referred to the Senate Committee on Finance. Cosponsors (6): Sens. Paul (R-KY), Brown (D-OH), Wicker (R-MS), Sinema (D-AZ), Shaheen (D-NH), King (I-ME).

 

H.R. 576, Seniors Have Eyes, Ears, and Teeth Act

Introduced by Rep. Lucille Roybal-Allard (D-CA), this measure expands Medicare coverage to eyeglasses, hearing aids, and dental care. Status: Referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. Cosponsors (86): Reps. Aguilar (D-CA), Beatty (D-OH), Sanford Bishop (D-GA), Blumenauer (D-OR), Bonamici (D-OR), Boyle (D-PA), Brownley (D-CA), Bustos (D-IL), Carson (D-IN), Chu (D-CA), Cicilline (D-RI), Clarke (D-NY), Cohen (D-TN), Connolly (D-VA), Correa (D-CA), DeFazio (D-OR), DeLauro (D-CT), DelBene (D-WA), DeSaulnier (D-CA), Deutch (D-FL), Dingell (D-MI), Espaillat (D-NY), Foster (D-IL), Gallego (D-AZ), Garamendi (D-CA), Vicente Gonzalez (D-TX), Grijalva (D-AZ), Heck (D-WA), Brian Higgins (D-NY), Jackson Lee (D-TX), Robin Kelly (D-IL), Kilmer (D-WA), Langevin (D-RI), Larsen (D-WA), Barbara Lee (D-CA), Loebsack (D-IA), Lowenthal (D-CA), Sean Patrick Maloney (D-NY), Matsui (D-CA), McCollum (D-MN), McEachin (D-VA), Meng (D-NY), Moore (D-WI), Moulton (D-MA), Napolitano (D-CA), Norton (D-DC), O’Halleran (D-AZ), Pocan (D-WI), Kathleen Rice (D-NY), Ruiz (D-CA), Rush (D-IL), Ryan (D-OH), Sablan (D-MP)< Sarbanes (D-MD), Schakowsky (D-IL), Schiff (D-CA), Bobby Scott (D-VA), Serrano (D-NY), Sewell (D-AL), Sherman (D-CA), Soto (D-FL), Suozzi (D-NY), Swalwell (D-CA), Takano (D-CA), Bennie Thompson (D-MS), Titus (D-NV), Tonko (D-NY), Torres (D-CA), Veasey (D-TX), Vela (D-TX), Velazquez (D-NY), Wasserman Schultz (D-FL), Watson Coleman (D-NJ), Welch (D-VT), Frederica Wilson (D-FL), Peters (D-CA), Lieu (D-CA), Kaptur (D-OH), Bass (D-CA), Barragan (D-CA), Doggett (D-TX), Al Green (D-TX), Castor (D-FL), Haaland (D-NM), Finkenauer (D-IA).

 

H.R. 1393, Medicare Dental, Vision, and Hearing Benefit Act

Introduced by Rep. Lloyd Doggett (D-TX), this measure includes vision, dental, and hearing aid coverage under Medicare. The hearing provision includes coverage of audiology and hearing services, as well as coverage for hearing aids and classifies hearing aids as durable medical equipment. The bill phases in the payment amount over 8 years, peaking at 80%. Status: Referred to the House Committee on Energy and Commerce and the House Committee on Ways and Means. Cosponsors (50): Reps. Chu (D-CA), Grijalva (D-AZ), Khanna (D-CA), Andy Levin (D-MI), McCollum (D-MN), Moore (D-WI), Norton (D-DC), Sewell (D-AL), Pingree (D-ME), Lewis (D-GA), Blumenauer (D-OR), Eddie Bernice Johnson (D-TX), Schakowsky (D-IL), Kaptur (D-OH), Tonko (D-NY), Serrano (D-NY), Mike Levin (D-CA), Ruiz (D-CA), Lujan (D-NM), Carolyn Maloney (D-NY), Barbara Lee (D-CA), Titus (D-NV), Suozzi (D-NY), Ryan (D-OH), McGovern (D-MA), Trone (D-MD), Mike Thompson (D-CA), Nadler (D-NY), Evans (D-PA), Dingell (D-MI), DeFazio (D-OR), Pocan (D-WI), Roybal-Allard (D-CA), Perlmutter (D-CO), Sanford Bishop (D-GA), Cohen (D-TN), DeLauro (D-CT), Meng (D-NY), Napolitano (D-CA), Porter (D-CA), Speier (D-CA), Yarmuth (D-KY), Payne (D-NJ), Sablan (D-MP), Trahan (D-MA), Jesus “Chuy” Garcia (D-IL), Cartwright (D-PA), Langevin (D-RI), Raskin (D-MD), Takano (D-CA).

 

S. 1423, Medicare and Medicaid Dental, Vision, and Hearing Benefit Act

Introduced by Sen. Bob Casey (D-PA), this measure includes vision, dental, and hearing aids under Medicare. This measure is similar to H.R. 1393, the Medicare Dental, Vision, and Hearing Benefit Act. Status: Referred to the Senate Committee on Finance. Cosponsor (1): Sen. Cardin (D-MD).

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