Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025
Sponsored By: Senator Angela Alsobrooks
Introduced
Summary
Adds dental, vision, and hearing coverage to Medicare and boosts Medicaid matching for those services. It would make routine exams, eyeglasses and contact lenses, hearing aids, and dental care part of covered benefits with limits and new payment rules.
Show full summary
- Seniors and Medicare enrollees: Would gain coverage for routine dental cleanings and exams, basic and major dental care, emergency dental care, dentures, eye exams, glasses, contact lenses, hearing exams, and hearing aids. Routine dental visits are generally limited to two per year and hearing aids are limited to one per ear every 48 months.
- States and Medicaid enrollees: States would receive a 90% Federal Medical Assistance Percentage for adult dental, vision, and hearing services, reducing state costs for those benefits.
- Payment and program rules: Medicare payment rates would phase in to 80% over eight years using the physician fee schedule as the payment basis. The Health Secretary could impose utilization controls such as prior authorization and set minimum hearing loss criteria for hearing aid coverage.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Federal pays 90% for adult Medicaid
If enacted, the federal government would pay 90% of state Medicaid costs for the newly covered adult dental, vision, and hearing services. The 90% match would apply to services furnished on or after January 1 of the first calendar year that begins at least six months after enactment. It would not apply to services for people under age 21 who get pediatric services.
Medicaid adds dental, vision, hearing
If enacted, Medicaid would explicitly cover adult dental, vision, and hearing services. This change would apply to services given on or after January 1 of the first calendar year that begins at least six months after enactment. The bill lists specific service definitions that apply. This would expand what adult enrollees could get through their state Medicaid program.
New Medicare dental, dentures coverage
If enacted, Medicare would cover many dental services and dentures starting for services given on or after January 1 of the first calendar year that begins at least six months after enactment. Medicare payments would phase in starting six months after enactment: 0% the first year, then rise by 10 percentage points each year through year seven, and reach 80% in year eight and later. Routine cleanings and exams would be payable up to two per 12 months. Dentures would be limited to certain types once every five years. The Secretary could add limits like prior authorization.
Sponsors & CoSponsors
Sponsor
Angela Alsobrooks
MD • D
Cosponsors
Richard Blumenthal
CT • D
Sponsored 6/12/2025
John Fetterman
PA • D
Sponsored 6/12/2025
Jeff Merkley
OR • D
Sponsored 6/12/2025
Peter Welch
VT • D
Sponsored 6/12/2025
Roll Call Votes
No roll call votes available for this bill.
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