As the cost of President Joe Biden’s spending envelope grows from $ 3.5 trillion to over $ 2,000 billion, Senator Bernie Sanders’ proposal to add dental, vision and hearing coverage to Medicare has grown. a sticking point in negotiations. Democrats such as Rep. Jim Clyburn of South Carolina, who oppose Sanders, would like to prioritize spending to benefit low-income people, including providing health insurance to the poor in states that have refused to pay. expand Medicaid.
There is a way to compromise: add new benefits to Medicare without spending so much that there is no room in the budget to help Medicaid needy.
Rather than simply offering dental, visual and hearing benefits to all Medicare beneficiaries, create an optional enrollment policy. This would allow seniors to take advantage of the purchasing power of the federal government while limiting the cost to taxpayers. This would keep Medicare solvent longer. and it would provide standardized plans for beneficiaries – rather than the patchwork of coverages now available to those signing up for Medicare Advantage or additional Medicare plans.
Older Americans clearly need affordable dental, vision and hearing coverage. The only question is how best to pay for it. An enrollment program could be structured like the Affordable Care and Prescription Drug Delivery Act Medicare Part D, both of which provide grants to people below a certain income threshold.
As it is, many people simply do without dental, hearing and vision care. In a 2018 survey of Medicare beneficiaries, on their behavior over the course of a year, the Commonwealth Fund found that 70% of those with dental problems had not seen a dentist, 43% of those who did. had vision problems did not have eyes. examination, and 75% of those who needed hearing aids did not. Plus, those with coverage – through a supplemental policy or Medicare Advantage – had to pay a large portion of the costs themselves. The Kaiser Family Foundation found that it spent an average of $ 874 on dental care, $ 230 on vision care, and $ 914 on hearing services.
Almost half of Medicare beneficiaries do not have dental coverage, and even those who do forgo routine preventive care because of the high out-of-pocket costs. This can worsen their chronic health problems and cause preventable complications that lead them to the emergency room.
Vision care is more affordable. Commonwealth analysis of Medicare survey data found that beneficiaries spent an average of $ 715 on vision services in a year, 60% of which was out of pocket. This cost is lower than dental care because Medicare covers some vision-related conditions: Party B (which provides services outside of hospitals) pays for an annual eye exam to check for diabetic retinopathy, glaucoma and degeneration. macular. However, the program does not cover routine eye exams, glasses or contact lenses.
When it comes to hearing care, mid-range hearing aids cost around $ 4,500, although they can run as high as $ 7,000. There is continued pressure to increase competition by making them available over the counter, including via an executive order from Biden. But this has yet to be approved by the Food and Drug Administration.
The Commonwealth Fund has estimated that a modest buy-back policy to cover dental, vision and hearing services – with a $ 150 deductible, 20% coinsurance (beneficiaries’ share of costs) and an annual benefit limit of $ 1,500 – could be offered for about $ 25 per year. month. This assumes that at least 70% of eligible and uninsured Medicare beneficiaries would enroll. Premiums and cost sharing could be subsidized for people with incomes reaching 150% of the poverty line.
Such a program would raise nearly $ 2 billion a year in premiums, and it would cover some 6.4 million Medicare beneficiaries above 150 percent of the poverty line. The cost of subsidizing about 2.4 million people below this income threshold would be just over $ 1 billion per year. That’s far less than the $ 80 billion a year that the Congressional Budget Office said Congress’ current proposal would cost. A voluntary program would also avoid disrupting the current Medicare Advantage formula and instead encourage Advantage plans to offer their own more competitive dental, vision and hearing benefits.
By creating an optional buy-back policy like this, Democrats could give Medicare beneficiaries better access to dental, vision, and hearing services – and leave room in the budget to provide Medicaid coverage to poor people in states that refused to expand this program. They could protect low-income seniors, standardize benefits for everyone, and protect Americans most vulnerable.