Medicare Dental, Vision, and Hearing Benefit Act of 2025

Bill Number

H.R. 2045

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-03-11: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Last Updated

2026-06-16T14:55:12Z

AI-Generated Summary

Purpose

The Medicare Dental, Vision, and Hearing Benefit Act of 2025 aims to expand the Medicare program (specifically Part B, which covers outpatient services) by adding coverage for dental, vision, and hearing care. These services are currently excluded from standard Medicare benefits, and the bill seeks to improve access to preventive and essential care for older adults and people with disabilities.

Key Provisions

• Dental and Oral Health Coverage:
• Includes preventive services (e.g., exams, cleanings, X-rays, fluoride treatments), basic services (e.g., fillings, extractions), major services (e.g., crowns, root canals), emergency care, and other related needs as defined by the Secretary of Health and Human Services (HHS).
• Payments start at 100% for preventive services in 2026, with other services phasing in: 0% before 2027, 30% in 2027, 60% in 2028, and 80% from 2029 onward. Low-income individuals (those eligible for Medicare drug plan subsidies) get 100% for preventive and 80% for others starting earlier.
• Limits: Up to two cleanings and two exams per year; dentures covered at 80% from 2027, with one set per type every five years.
• Secretary's authority: Can impose prior authorization (pre-approval for services), adjust limits based on U.S. Preventive Services Task Force (USPSTF) recommendations, or waive frequency rules if needed.

• Vision Care Coverage:
• Covers routine eye exams to check refractive error (how the eye focuses light) and other eye health services as defined by the Secretary.
• Payments at 80% of the approved amount (the lesser of actual charge or a fee schedule).
• Limits: One routine exam per year; eyeglasses/contact lenses capped at $100 for lenses/frames every 12-24 months and $200 for contacts every 24 months (adjusted for inflation from 2027); low vision devices (special magnifiers or enhancers, excluding standard glasses) at 80%.
• Secretary's authority: Similar to dental, including prior authorization and USPSTF-based adjustments.

• Hearing Care Coverage:
• Covers audiology services (diagnostic hearing tests) and hearing services (routine exams for hearing aids and related needs as defined by the Secretary).
• Payments at 80% of the approved amount.
• Limits: One hearing aid per ear every 48 months; minimum hearing loss criteria may apply.
• Secretary's authority: Can add limits like prior authorization or USPSTF adjustments.

• General Rules:
• All changes apply to services starting January 1, 2026.
• These services are paid under the Medicare physician fee schedule (a standard payment system for doctors and providers).
• Excludes dentures, eyeglasses, contact lenses, and hearing aids from competitive bidding (a process to control costs for medical supplies).
• Adds at least one oral health professional to the USPSTF (an expert panel advising on preventive care recommendations), effective six months after enactment.

Significant Changes to Existing Law

• Amends the Social Security Act (Title XVIII, which governs Medicare) to explicitly include dental, vision, and hearing as covered services under Section 1861(s)(2), reversing long-standing exclusions (e.g., Section 1862(a) previously barred routine dental, eyeglasses, and hearing aids).
• Redefines "durable medical equipment" (items like wheelchairs that Medicare covers) to include eyeglasses, contact lenses, low vision devices, and hearing aids.
• Introduces phased coverage for dental to ease implementation, unlike immediate full coverage for vision and hearing.
• Grants HHS broad flexibility to modify benefits based on evidence from the USPSTF, potentially allowing future tweaks without new legislation.

Potential Impacts

• On Citizens: Medicare beneficiaries (about 65 million older adults and disabled people) gain access to essential care, potentially reducing out-of-pocket costs (currently, many pay fully for these services) and improving health outcomes, like preventing infections from untreated dental issues or falls from poor vision/hearing.
• On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) must update payment systems, process claims, and enforce limits, increasing administrative workload. Overall Medicare spending could rise significantly (estimates not in bill, but expansions like this historically add billions annually).
• On International Relations: Minimal direct impact, though it may indirectly support U.S. health policy discussions in global forums like the World Health Organization by emphasizing preventive care for aging populations.
• Broader effects: Could lower emergency room visits for untreated conditions, saving long-term costs, but initial expansion might strain budgets without offsets.

Main Stakeholders Affected

• Medicare Beneficiaries: Primary beneficiaries, especially low-income seniors who currently forgo care due to costs.
• Healthcare Providers: Dentists, optometrists, audiologists, and ophthalmologists gain new reimbursement streams; may see increased patient volume.
• Government Entities: CMS and HHS for implementation; Congress and taxpayers for funding the expanded benefits.
• Insurers and Advocates: Private Medicare Advantage plans must align with new rules; groups like AARP or disability advocates benefit from broader access.
• Medical Suppliers: Manufacturers of hearing aids, glasses, and dentures face new coverage but exclusions from bidding could stabilize markets.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens Medicare's preventive focus by tying adjustments to USPSTF (an independent advisory body), but the Secretary's broad authority for limits or waivers could lead to challenges if seen as arbitrary (e.g., under the Administrative Procedure Act, which requires fair rulemaking). Repeals exclusions without new barriers, promoting equity in benefits.
• Constitutional: Aligns with Congress's enumerated power to tax and spend for public welfare (Article I, Section 8), as it expands an existing federal entitlement program without infringing on states or individual rights.
• Political: Represents a push to modernize Medicare amid aging demographics (e.g., baby boomers), but could spark debates on costs and fiscal responsibility; introduced by over 100 House members (mostly Democrats), it may face partisan hurdles in funding or passage, potentially influencing midterm elections or entitlement reform discussions.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Doggett, Lloyd [D-TX-37]

Cosponsors (131)

Rep. Adams, Alma S. [D-NC-12], Rep. Ansari, Yassamin [D-AZ-3], Rep. Balint, Becca [D-VT-At Large], Rep. Barragán, Nanette Diaz [D-CA-44], Rep. Beatty, Joyce [D-OH-3], Rep. Beyer, Donald S. [D-VA-8], Rep. Bishop, Sanford D. [D-GA-2], Rep. Bonamici, Suzanne [D-OR-1], Rep. Boyle, Brendan F. [D-PA-2], Rep. Carson, André [D-IN-7], Rep. Carter, Troy A. [D-LA-2], Rep. Casar, Greg [D-TX-35], Rep. Castro, Joaquin [D-TX-20], Rep. Chu, Judy [D-CA-28], Rep. Cleaver, Emanuel [D-MO-5], Rep. Cohen, Steve [D-TN-9], Rep. Connolly, Gerald E. [D-VA-11], Rep. Crockett, Jasmine [D-TX-30], Rep. Cuellar, Henry [D-TX-28], Rep. Davis, Danny K. [D-IL-7], Rep. Dean, Madeleine [D-PA-4], Rep. DeGette, Diana [D-CO-1], Rep. McClain Delaney, April [D-MD-6], Rep. DeLauro, Rosa L. [D-CT-3], Rep. Deluzio, Christopher R. [D-PA-17], Rep. DeSaulnier, Mark [D-CA-10], Rep. Dexter, Maxine [D-OR-3], Rep. Dingell, Debbie [D-MI-6], Rep. Escobar, Veronica [D-TX-16], Rep. Espaillat, Adriano [D-NY-13], Rep. Evans, Dwight [D-PA-3], Rep. Leger Fernandez, Teresa [D-NM-3], Rep. Fields, Cleo [D-LA-6], Rep. Friedman, Laura [D-CA-30], Rep. Frost, Maxwell [D-FL-10], Rep. Garamendi, John [D-CA-8], Rep. García, Jesús G. "Chuy" [D-IL-4], Rep. Garcia, Robert [D-CA-42], Rep. Garcia, Sylvia R. [D-TX-29], Rep. Goldman, Daniel S. [D-NY-10], Rep. Gottheimer, Josh [D-NJ-5], Rep. Green, Al [D-TX-9], Rep. Grijalva, Raúl M. [D-AZ-7], Rep. Hayes, Jahana [D-CT-5], Rep. Hoyle, Val T. [D-OR-4], Rep. Huffman, Jared [D-CA-2], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Jacobs, Sara [D-CA-51], Rep. Jayapal, Pramila [D-WA-7], Rep. Johnson, Henry C. "Hank" [D-GA-4] and 81 more

Recent Actions

• 2025-03-11: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-03-11: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2025-03-11: Introduced in House
• 2025-03-11: Introduced in House

Bill Versions

• Medicare Dental, Vision, and Hearing Benefit Act of 2025 — issued 2025-03-11 — PDF (25 pages)