Sponsors (131)
Introduced March 11, 2025 by Lloyd Alton Doggett · Last progress March 11, 2025
The bill significantly expands Medicare coverage for dental, vision, and hearing services—improving access and lowering some costs for many beneficiaries—while retaining limits, caps, and administrative controls that leave substantial out‑of‑pocket exposure for some, add program complexity, and increase federal spending.
Medicare beneficiaries (especially seniors and low‑income enrollees) gain new Part B coverage for many dental/oral health services (including preventive and some restorative care), improving access to dental care.
Medicare beneficiaries gain coverage for routine eye exams, eyewear support (lenses, frames, contacts) with price protections, and low‑vision devices, lowering barriers to vision care and assistive devices.
Medicare beneficiaries (seniors and people with disabilities) receive coverage and payment support for audiology services and hearing aids (included as DME), improving access to hearing care.
Many covered services are phased in, subject to dollar caps, or limited payment percentages, leaving large numbers of beneficiaries with substantial remaining out‑of‑pocket costs (especially for higher‑cost eyewear, dental procedures, and hearing aids).
Strict frequency limits (e.g., two dental cleanings/year cap, one eye exam/year, one hearing aid per ear every 48 months, denture frequency limits) risk leaving beneficiaries with unmet clinical needs or needing additional private care.
The Secretary's authority to require prior authorization, set minimum clinical criteria, and impose other reasonable limitations raises administrative burdens, slows access, and increases billing/compliance complexity for beneficiaries and providers.
Based on analysis of 6 sections of legislative text.
Adds dental, vision, and hearing services (including aids and routine exams) to Medicare Part B with defined payment rules, phased-in coverage, and new HHS authority to set limits.
Adds dental, vision, and hearing benefits to Medicare Part B by creating new benefit categories, defining covered services (preventive, basic, major, routine exams, eyeglasses, contact lenses, hearing aids, and related items), and establishing Part B payment rules with phased-in payment percentages beginning in 2026. Gives the Secretary of HHS authority to define necessary services and impose reasonable limits or prior authorization, excludes certain items from competitive acquisition, and requires the USPSTF to include an oral health professional.