Medicare Dental, Vision, and Hearing Benefit Act of 2025
Medicare Dental, Vision, and Hearing Benefit Act of 2025 would expand Medicare (Title XVIII) to cover dental, vision, and hearing care starting in 2026. The bill defines these new benefit areas, specifies what counts as covered services (from routine checkups to dentures, glasses, contact lenses, hearing aids, and related treatments), and begins a phased payment structure toward broader coverage. It also gives the Secretary of Health and Human Services broad authority to impose limits, require prior authorization, and adjust coverage consistent with USPSTF recommendations. In addition, the bill makes several administrative changes (such as removing certain exclusions for these items from Medicare purchasing rules and ensuring USPSTF includes an oral health professional) and sets specific frequency limits and dollar rules for several items (e.g., routine exams, dentures, eyeglasses, hearing aids). Overall, the measure aims to reduce out-of-pocket costs and expand access to routine dental, vision, and hearing care for Medicare beneficiaries. Effective dates are staggered, with many provisions applying to services furnished on or after January 1, 2026, and some implementation details linked to the first year beginning at least six months after enactment.
Key Points
- 1Expands Medicare coverage to include dental, vision, and hearing care as part of the program, with new benefit definitions and service categories for each area.
- 2Phased payment structure with notable coverage targets:
- 3- 100% payment for certain described dental/vision/hearing services in 2026 for those services; other services begin with lower coverage that ramps up over time (0% in 2026 for some services not described, then 30% in 2027, 60% in 2028, and 80% from 2029 onward for many services); low-income subsidy individuals receive higher (often 100%) coverage for many services.
- 4- Specific 80% coverage for dentures (starting 2027), eyeglasses/contacts/low-vision devices (with caps and inflation adjustments), and hearing aids (starting 2027), subject to caps and potential department rules.
- 5Defined limits and administrative tools:
- 6- Routine dental cleanings limited to two per 12 months; routine exams limited to two per 12 months.
- 7- Dentures limited to one full upper and one full lower denture per five years (and one partial upper and one partial lower per five years); hearing aids limited to one per ear every 48 months.
- 8- Secretary empowered to impose additional limitations (e.g., prior authorization) and to modify coverage in line with USPSTF recommendations; authority to waive frequency limits in appropriate cases.
- 9- Inflation-adjusted updates to certain payment limits (e.g., eyeglasses/contacts starting 2027).
- 10Scope of coverage defined for each area:
- 11- Dental and oral health services: preventive, basic, major, emergency, and other necessary services defined by the Secretary.
- 12- Vision services: routine eye exams and related vision health services defined by the Secretary.
- 13- Hearing services: audiology services and hearing services defined by the Secretary; includes routine hearing exams and exams for hearing aids.
- 14- Related devices: dentures, eyeglasses/frames, contact lenses, low-vision devices, and hearing aids included with specific payment rules and limits.
- 15Administrative and policy changes:
- 16- Nonapplication of competitive acquisition rules to dentures, eyeglass lenses/frames, contact lenses, and hearing aids (i.e., those items are exempt from certain bidding requirements).
- 17- USPSTF membership expanded to include at least one oral health professional.
- 18Effective date: Most provisions apply to services furnished on or after January 1, 2026; USPSTF membership change becomes effective in the first year beginning at least six months after enactment.