Medicare Dental, Hearing, and Vision Expansion Act of 2025

Bill Number: S. 939
Origin Chamber: Senate
Congress: 119th Congress, Session 1
Policy Area: Health
Status: Introduced
Latest Action: 2025-03-11: Read twice and referred to the Committee on Finance.
Last Updated: 2026-05-14T21:23:47Z

AI-Generated Summary

Purpose

The Medicare Dental, Hearing, and Vision Expansion Act of 2025 aims to expand Medicare Part B (the outpatient insurance part of Medicare for people 65 and older or with certain disabilities) by adding coverage for routine dental and oral health services, hearing care (including hearing aids), and vision care (including eye exams and eyeglasses). This addresses current gaps in Medicare, which generally excludes these services unless tied to other medical treatments. Coverage begins mostly on January 1, 2027 (earlier for dentures in 2026), with payments structured to control costs and phase in premium increases gradually.

Key Provisions

Dental and Oral Health Coverage:
Includes preventive services (e.g., exams, cleanings, X-rays, fluoride treatments), treatments for oral disease (e.g., fillings, crowns, root canals, extractions), and dentures/implants.
Excludes cosmetic services and items already allowed under limited existing rules.
Provided by dentists or licensed oral health professionals (e.g., dental hygienists acting within state scope).
Payment: 80% of approved amount (100% for preventive services), based on a new fee schedule using 70% of national median fees from a 2020 dental survey, adjusted for geography, inflation, and productivity. Rural providers get a 10% incentive.
Limits: e.g., 2 exams/cleanings per year, 1 fluoride treatment per year, 1 full X-ray series every 3 years.
Special rules for rural health clinics and federally qualified health centers (FQHCs) with temporary payment rates based on physician fees until 2031.

Hearing Care Coverage:
Expands audiology services (e.g., hearing/balance assessments, aural rehabilitation) without needing a doctor's order starting 2027.
Covers hearing aid exams by qualified professionals (e.g., licensed hearing aid dispensers accredited by national boards) and hearing aids for moderately severe to profound hearing loss.
Hearing aids treated as prosthetic devices; provided by qualified suppliers (e.g., audiologists, physicians).
Payment: 80% for exams; hearing aids limited to once per ear every 5 years, only certain types, via written order from authorized providers. Prices capped at federal supply schedule rates; competitive bidding starts by 2031.
Exempts physician-provided hearing aids from some bidding rules initially.

Vision Care Coverage:
Covers routine eye exams (to check refractive error, like nearsightedness) every 2 years, provided by ophthalmologists or optometrists under state law.
Expands eyeglasses coverage to one pair every 2 years (beyond just post-cataract surgery), excluding deluxe or reading glasses.
Payment: Under existing physician fee schedule; prices capped at federal supply schedule rates; competitive bidding starts by 2030.
Exception: Extra pair allowed post-cataract surgery within the 2-year period.

General Rules Across Services:
Modifies exclusions in Medicare law to allow these benefits.
Includes them as "excepted medical treatment" in nursing homes.
Applies assignment rules (providers accept Medicare payment as full fee) and limits beneficiary liability for non-participating providers.
Designates contractors to handle claims and policies.
Temporary implementation via guidance for 2027-2028; rural clinics/FQHCs get adjusted payments.

Premium Phase-In for Dental Coverage:
From 2026-2030, Part B premiums (monthly payments by beneficiaries) use an "alternative" rate that ignores dental costs initially, then phases them in: 0% in 2026-2027, 25% in 2028, 50% in 2029, 75% in 2030. This delays full cost impact on premiums.

Funding:
Allocates $900 million for dental implementation (2025-2034), $370 million for hearing (2026-2035), and $500 million for vision (2026-2034) from general Treasury funds.

Significant Changes to Existing Law

Adds New Benefits: Medicare Part B currently excludes routine dental, vision, and hearing services (except limited cases, like eyeglasses after cataract surgery). This bill explicitly includes them as covered services under Section 1861(s)(2), with definitions in new subsections (nnn for dental, updates to ll for hearing, ooo for vision).
Payment System Overhauls: Introduces a dedicated dental fee schedule (Section 1834(aa)) based on median fees, unlike physician fees. Applies prosthetic device rules and competitive acquisition (bidding among suppliers) to hearing aids and eyeglasses starting 2030-2031, with caps tied to federal schedules.
Provider Expansions: Recognizes non-physician providers (e.g., oral health professionals, audiologists, hearing aid specialists) for direct billing and assignment (Section 1842(b)(18)). Removes physician order requirements for audiology.
Exclusion Adjustments: Amends Section 1862(a) to lift bans on these services, with frequency limits to prevent overuse.
Premium Protections: New Section 1839(a)(8) creates a phased premium calculation to shield beneficiaries from immediate dental cost increases.
Rural and Facility Updates: Extends coverage to rural health clinics and FQHCs (Section 1861(aa)), with temporary fee-based payments (Sections 1833 and 1834(o)) and disregards these costs in all-inclusive rates.

Potential Impacts

On Government Agencies: The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) will face increased administrative workload for new claims processing, fee schedules, and competitive bidding. Upfront funding covers setup, but long-term Medicare spending will rise (e.g., phased premium impact estimated to add costs gradually). Could strain budgets without offsets.
On Citizens (Medicare Beneficiaries): Improves access to essential care for ~66 million enrollees, reducing out-of-pocket costs (e.g., no more full payment for dentures or hearing aids). Limits prevent unlimited use. Phased premiums minimize short-term hikes, but full costs hit by 2031, potentially increasing premiums by 5-10% long-term based on utilization.
On Providers and Facilities: Dentists, audiologists, optometrists, and related professionals gain new reimbursement streams, encouraging participation (especially rural incentives). Rural clinics/FQHCs benefit from adjusted payments, potentially expanding services in underserved areas.
On International Relations: Minimal direct impact, as this is a domestic health program; indirect effects could include U.S. leadership in elderly care models.

Main Stakeholders Affected

Medicare Beneficiaries: Primary beneficiaries, especially older adults with chronic conditions (e.g., diabetes-linked oral issues, age-related hearing/vision loss).
Health Care Providers: Dentists, oral health professionals, audiologists, hearing aid specialists, ophthalmologists, optometrists, and suppliers of aids/eyeglasses/prosthetics.
Facilities: Rural health clinics, FQHCs, and nursing homes, which can now bill for these services.
Government Entities: HHS/CMS for implementation; Congress for funding and oversight; Treasury for appropriations.
Insurers and Payers: Medicare Advantage plans may need to align with new benefits; indirect effects on private insurers via benchmark changes.
Advocacy Groups: Organizations like the American Dental Association or AARP, representing providers and seniors.

Notable Legal, Constitutional, or Political Implications

Legal: Strengthens Medicare as an entitlement program by filling coverage gaps, but introduces frequency limits and exclusions (e.g., cosmetics) to comply with anti-fraud rules (e.g., Section 1877 physician self-referral exceptions phased in to prevent abuse). Relies on state licensing for providers, potentially leading to interstate variations or lawsuits if states resist. Competitive acquisition ensures fair pricing but could face provider challenges if bids are too low.
Constitutional: No major issues; expands existing federal spending power under the Social Security Act without infringing rights. Appropriations are straightforward congressional authority.
Political: Politically progressive, aligning with efforts to broaden Medicare (e.g., similar to past expansions like preventive care). Could reduce health disparities but draws criticism for adding $20-30 billion annually to deficits without revenue sources. Phase-in softens opposition from premium-sensitive voters; introduced by Democrats, it may spark partisan debates on entitlement growth vs. fiscal restraint.

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

Sponsor

Sen. Sanders, Bernard [I-VT]

Cosponsors (8)

Sen. Warren, Elizabeth [D-MA], Sen. Booker, Cory A. [D-NJ], Sen. Welch, Peter [D-VT], Sen. Markey, Edward J. [D-MA], Sen. Duckworth, Tammy [D-IL], Sen. Merkley, Jeff [D-OR], Sen. Blumenthal, Richard [D-CT], Sen. Schiff, Adam B. [D-CA]

Recent Actions

2025-03-11: Read twice and referred to the Committee on Finance.
2025-03-11: Introduced in Senate

Bill Versions

Medicare Dental, Hearing, and Vision Expansion Act of 2025 — issued 2025-03-11 — PDF (43 pages)