Sponsors (9)
Official title: Amend title XVIII of the Social Security Act to provide coverage for dental and oral health care, hearing care, and vision care under the Medicare program.
Introduced March 11, 2025 by Bernard Sanders · Last progress March 11, 2025
The bill significantly expands Medicare benefits for dental, hearing, and vision—improving access and lowering some out‑of‑pocket costs for seniors and people with disabilities—while introducing new cost sharing, payment caps, and administrative complexity that could limit provider participation, constrain choice, and shift costs over time.
Medicare beneficiaries (seniors and people with disabilities) gain comprehensive new coverage for dental care—preventive services at 100% and coverage for restorative/prosthetic treatments (including dentures)—reducing out‑of‑pocket costs for common and necessary oral health care.
Medicare beneficiaries with moderate‑to‑profound hearing loss gain Part B coverage for hearing aids and related services (starting Jan 1, 2027), and may access audiology care more directly without a physician order, lowering costs and easing access to hearing care.
Medicare beneficiaries gain routine vision benefits—coverage for one routine eye exam and one pair of conventional eyeglasses every two years (with a post‑cataract exception)—reducing OOP costs for basic vision correction and screening.
Many Medicare beneficiaries will still face new or ongoing out‑of‑pocket costs—coinsurance (e.g., 20% for many dental services), limits on covered items, and phased‑in premium/deductible increases that raise costs over 2028–2030.
Payment caps and below‑market fee formulas (dental at 70% of national median, hearing/vision tied to older GSA/Fee Schedule rates and other reduced formulas) risk lowering provider reimbursement, which could reduce provider participation and access in some areas.
Strict frequency limits (hearing aids once per 5 years; one eye exam and one pair of glasses every 2 years) could delay necessary replacements or monitoring for beneficiaries whose devices fail or whose vision/hearing changes sooner, harming health outcomes.
Based on analysis of 5 sections of legislative text.
Adds dental, hearing, and vision coverage to Medicare Part B with payment rules, a $900M implementation appropriation, and a 2026–2030 premium phase-in for dental costs.
Adds dental, hearing, and vision benefits to Medicare Part B and sets payment and provider rules for each service; most new coverage begins January 1, 2027 (dentures may begin Jan 1, 2026). Establishes fee schedules and payment shares for dental services, expands coverage and provider eligibility for hearing aids and audiology services, and covers routine eye exams and a biennial eyeglass benefit. Provides $900 million to HHS for implementation and creates a five-year special rule (2026–2030) that phases in how the Part B monthly premium, deductible, and related adjustments incorporate the cost of the new dental benefit to limit immediate premium increases for older enrollees.