S 939119th CongressIn Committee

Medicare Dental, Hearing, and Vision Expansion Act of 2025

Introduced: Mar 11, 2025

Standard Summary

Comprehensive overview in 1-2 paragraphs

The Medicare Dental, Hearing, and Vision Expansion Act of 2025 would add comprehensive dental and oral health care, hearing care (audiology and hearing aids), and vision care to Medicare Part B benefits. The bill sets up defined services, payment rules, and implementation steps to begin coverage in 2027 (with dentures start date in 2026 for certain items). It introduces a new 3-part expansion: (1) dental and oral health services with a new 1861(nnn) definition and a federal fee schedule; (2) hearing care, including audiology services, hearing aid examinations, and hearing aids with limits and assignment-based payments; (3) vision care, defining routine eye exams and glasses coverage with time-based limits. The act also creates a dental administrator to manage coverage policies and claims, expands Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to provide these services, and provides funding for implementation and ongoing administration. Overall, the bill shifts Medicare toward broader, federally funded access to routine preventive and some advanced services in dentistry, hearing, and vision, while tying payments to new schedules and annual updates.

Key Points

1Dental and oral health coverage and definitions
2- Adds dental and oral health services to Medicare Part B, defined as preventive exams, cleanings, x-rays, fillings, prosthodontics (including dentures and implants), and other related care starting January 1, 2027 (January 1, 2026 for dentures).
3- Establishes a new category “dental and oral health services” with exclusions for purely cosmetic or already-covered services; introduces an oral health professional definition.
4- Sets frequency limits for preventive services (e.g., up to 2 exams, 2 cleanings, 1 fluoride treatment per year; full-mouth x-rays limited to once every 3 years) and gives the Secretary discretion to set other frequencies.
5- Creates a national dental fee schedule (70% of the national median fee, adjusted regionally) plus 80% (or 100% for preventive) payment rules; dentures use a bundled payment; annual updates tied to CPI minus a productivity adjustment.
6- Provides incentives (a 10% add-on) for rural providers in Health Professional Shortage Areas and designates up to four Medicare administrative contractors to administer dental coverage and claims.
7- Expands coverage to Rural Health Clinics and FQHCs for dental services and addresses temporary payment rates in these settings.
8Hearing care coverage and payments
9- Expands audiology services and adds hearing aid examination services (beginning January 1, 2027) furnished by qualified hearing aid professionals or audiologists; allows these services to be provided without physician orders starting 2027.
10- Payments for hearing aid examinations and related services would be 80% of the lesser of the charge or 85% of a set payment basis; hearing aids (as prosthetics) are included in Medicare coverage beginning 2027 with limits.
11- Sets frequency limits for hearing aids (e.g., not more than once per ear per 5 years) and requires written orders; introduces competition (by 2031) for certain hearing aid services under the Medicare framework.
12- Allows assignment-based payments for audiologists and qualified hearing aid professionals (i.e., providers can accept Medicare assignment as payment in full) and updates the Physician Self-Referral Law to address hearing aids and services.
13Vision care coverage and payments
14- Adds vision services to Medicare Part B coverage, including routine eye exams for refraction and related procedures, to begin January 1, 2027.
15- Limits to 1 routine eye exam every 2 years; adds coverage for eyeglasses (including conventional eyeglasses or lenses) after cataract surgery with intraocular lens implantation, and for glasses as of 2027 for broader cases.
16- Payment rules tie to a Medicare physician fee schedule basis, with a separate 2-year eyeglass payment window and a cap on deluxe or reading glasses.
17- Applies competitive acquisition rules to eyeglasses in a manner similar to other items, with price caps tied to the Federal Supply Schedule.
18Implementation, funding, and administration
19- Creates a designated dental administrator (1-4 Medicare administrative contractors) to oversee coverage policies and claims for dental and oral health services.
20- Provides appropriations: $900 million (fiscal year 2025) to implement these changes through 2034; $370 million (fiscal year 2025) for 2026–2035 for hearing/vision provisions and expedited implementation.
21- Requires rapid implementation for 2027–2028 via program instructions and guidance.

Impact Areas

Primary group/area affected- Medicare beneficiaries, especially older adults and people with disabilities, who gain access to dental, hearing, and vision services that are largely not covered today under traditional Medicare.- Dental, audiology, and vision professionals who would bill Medicare for newly covered services; inclusion of oral health professionals and qualified hearing aid professionals as Medicare providers.Secondary group/area affected- Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), which would be eligible to furnish and be paid for these expanded services, potentially improving access in underserved areas.- States and insurers (including Medicare Advantage plans) that would interact with new coverage rules, fee schedules, and potential shifts in beneficiary cost-sharing and utilization.Additional impacts- Federal budget and program costs rise due to expanded benefits; new fee schedules and annual updates may influence overall Medicare spending and provider reimbursement patterns.- Beneficiary costs could still be influenced by coinsurance, as CMS payment is a portion of charges; preventive services have higher coverage (100%) under certain scenarios, potentially reducing out-of-pocket costs for preventive care.- Administrative and regulatory complexity increases, with the creation of a dental administrator and new definitions (e.g., oral health professionals, qualified hearing aid professionals) and new penalties or conditions (assignment-based payments, competitive acquisition for hearing aids, etc.).- Potential market effects on hearing aid pricing (competition beginning 2031) and eyewear pricing (FS schedule caps) as providers adapt to new Medicare payment rules.Assignment-related payment: Medicare pays the provider directly and the provider agrees to accept the Medicare-approved amount as full payment, limiting patient balance.Fee schedule: A list of payment rates CMS uses for services; here, it would be set for dental and oral health services and adjusted annually.Civil/service terms like “RHC AIR” and “FQHC PPS” refer to specific payment methods for rural clinics and federally qualified health centers.

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