Sponsors (132)
Official title: To amend title XVIII of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare program.
Introduced March 11, 2025 by Lloyd Alton Doggett · Last progress March 11, 2025
The bill significantly expands Medicare coverage for dental, vision, and hearing—improving access and reducing some out‑of‑pocket costs for many beneficiaries—while leaving important limits, phased cost‑sharing, and new administrative rules that could still produce gaps in care and increase federal spending.
Medicare beneficiaries (seniors and people with disabilities) gain new Part B coverage for dental, vision, and hearing services and devices, improving access to care they previously had to buy out-of-pocket.
Low‑income and other beneficiaries get meaningful payment support (e.g., low‑income payment floors, 80% cost-sharing for many items, and eyewear/hearing payment rules), which reduces out‑of‑pocket costs for many patients.
Routine preventive services and assistive device coverage (two dental cleanings/exams per year, annual eye exam, low‑vision DME, hearing aids as DME with some waiver flexibility) promote earlier detection and management of oral, vision, and hearing problems.
Many beneficiaries will still face substantial cost‑sharing because coverage phases in (0–80% floors) and benefit limits, and the expansion increases federal spending that may require offsets or affect Medicare finances.
Frequency limits and dollar caps (two dental cleanings per year, one eye exam per 12 months, eyewear price caps, hearing aid replacement every 48 months) may leave people with greater needs facing unmet care or paying significant additional out‑of‑pocket costs.
Broad authority for the Secretary to impose prior authorization, minimum‑loss or other criteria, and USPSTF‑linked modifications creates administrative barriers, delays, and access uncertainty for beneficiaries and adds compliance burden for providers.
Based on analysis of 6 sections of legislative text.
Adds dental, vision, and hearing (including hearing aids) as Medicare Part B benefits, sets Part B payment rules and phased cost-sharing, and permits CMS to set limits and prior authorization.
Adds dental, vision, and hearing services — including exams, treatments, and hearing aids — as Medicare Part B benefits, creates payment formulas and phased-in coverage, and allows the Secretary of HHS to set detailed definitions, limits, and prior authorization rules. Most benefit and payment rules take effect for services furnished on or after January 1, 2026, with some phased payment percentages in later years and a requirement that the USPSTF include an oral-health professional within a short timeframe after enactment. The bill defines the covered categories, sets Part B payment rules (including an "applicable percent" payment schedule and higher subsidy rates for certain low-income beneficiaries), adds limits (frequency caps and reasonable limitations) with waiver authority, treats hearing aids as durable medical equipment subject to Part B payment, and explicitly excludes dentures, eyeglass lenses, contact lenses, and hearing aids from a competitive acquisition program. It also requires the USPSTF to include at least one oral health professional.