A new paper in JAMA, by Amber Willink, Cathy Schoen and Karen Davis, explains why Medicare should cover dental, vision and hearing services. Right now, these three services, along with long-term care, are the biggest gaps in Medicare coverage. Lack of coverage for these services may lead to unnecessary hospitalizations and can push older adults into bankruptcy. Expanding Medicare to cover these services would benefit older adults, people with disabilities, health professionals and the Medicare program.
A survey of people with Medicare in 2012 reveals that most people with Medicare end up going without needed vision, dental and hearing care. Three-quarters of people surveyed reported hearing difficulties and more than four out of five of them (84 percent) did not have a hearing aid.
About 11 million people with Medicare (about 20 percent) said that they had trouble eating because of problems with their teeth, but seven in ten of them had not seen a dentist in the last year. (Here are some tips for getting free or low-cost dental care if you have Medicare.)
Another 20.5 million people with Medicare reported problems with their eyesight, yet more than half of them (57 percent) had not had an eye exam in the past year. (Here are four things to do to protect your eyesight.)
Cost is the primary reason people do not get these services. Hearing aids alone typically cost $4,700 for both ears. (That said, low-cost hearing aids may be available soon.) On average, people who received services spent $927 for dental services, $715 for vision services, and $1338 for hearing services.
Not surprisingly, people with incomes under 100 percent of the federal poverty level were far less likely to get these critical services than people with incomes over 400 percent of the federal poverty level. In most states, Medicaid does not pay for much if any vision, hearing or dental care.
People who forego this care are far more likely to be hospitalized or to need emergency care than people who receive treatment for their vision, hearing and dental needs. There are currently two bills in Congress that would cover these services, but for now they appear to be going nowhere.
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