Many Medicare beneficiaries face high reimbursable costs for dental and hearing care, whether under traditional Medicare or Medicare Advantage
Many Medicare beneficiaries face high annual fees for dental and hearing care – services that are generally not covered by traditional health insurance, but are generally covered by Medicare Advantage plans, although the scope and the value of these benefits vary, depending on a new KFF analysis.
The analysis shows that among recipients who used each type of service, the average annual out-of-pocket expenditure was $ 914 for hearing care and $ 874 for dental care in 2018, but considerably less ($ 230) for vision care. Among those who were in the top 10 percent in terms of out-of-pocket costs for such services, 2.7 million beneficiaries spent $ 2,136 or more on their dental care, while 360,000 beneficiaries spent $ 3,600. or more for hearing services.
According to the analysis, beneficiaries may face high out-of-pocket expenses, whether they are under a traditional Medicare plan or a private Medicare Advantage plan. Among dental service users, for example, average out-of-pocket expenses were $ 766 among Medicare Advantage recipients and $ 992 among traditional Medicare recipients in 2018.
The analysis also reveals that people with health insurance in communities of color, with disabilities, or with low income are disproportionately likely to have difficulty obtaining these services. About 16% of all Medicare beneficiaries said in 2019 that there had been a time in the past year when they couldn’t get dental, hearing or vision care, but this was reported by a higher percentage. high number of beneficiaries under 65 with long-term disability. (35%); those enrolled in both Medicare and Medicaid (35%); low income (eg 31% for those with income less than $ 10,000); and black and Hispanic beneficiaries (25% and 22%, respectively).
The new analysis also provides insight into the coverage of dental, hearing and vision services under Medicare Advantage plans. Although most plans provide coverage for these services, the extent of coverage varies and has limits.
- Almost all Medicare Advantage registrants with access to dental coverage have preventive care benefits, and most have access to more extensive dental benefits. Cost-sharing for more extensive dental services is typically 50 percent for networked care, and is typically subject to an annual dollar cap on plan payments.
- Likewise, almost all Medicare Advantage registrants have access to hearing tests and hearing aid coverage. Coverage is typically subject to an annual dollar cap and / or frequency limits on how often plans cover service.
- Virtually all Medicare Advantage registrants have access to eye exams and eyeglass coverage, typically subject to annual maximum limits of around $ 160 per year.
The findings come as policymakers in Congress consider adding dental, hearing and visual benefits to Medicare as part of the budget reconciliation bill, one of many competing spending priorities in the debate. This would be the biggest expansion of Medicare benefits since the launch of Part D drug delivery in 2006. (A similar proposal in 2019 would have increased Medicare spending by more than $ 300 billion over 10 years, according to the Congressional Budget Office.)