When elderly people were first created, they had no eyes, ears, or teeth. For this reason, when federal lawmakers got around to enacting Medicare insurance for seniors in 1965, they didn’t include vision services, hearing aids or dental care.
As one writer has suggested: “Teeth don’t know that they’re supposed to keep their problems confined to the mouth.” Research also shows that hearing loss and loss of vision can result in loneliness, isolation, depression and anxiety. These missing health links in Medicare turn out to be critical to overall well-being for seniors.
The 2021 Medicare & You booklet lists some of the items and services that original Medicare doesn’t cover including: most dental care; eye exams (for prescription glasses); dentures; and hearing aids and exams for fitting them.
Elderly people have to use their mouth to let Congress know that the Medicare program is an unfinished plan. The lobbying groups that fought Medicare as a form of “socialized medicine” have portrayed older people as mysteriously missing key parts of their anatomy that actually have been with them since birth.
As an example, dental care was left out of original Medicare. One of the major obstacles was the American Dental Association, which for years stood in the way of integrating dental services into Medicare. For more than half a century, the ADA argued against integrating dental care into elderly health care — despite the fact that poor dental care is linked to other health problems in the body. Inflammation and bacteria caused by neglect of dental care can worsen conditions like diabetes and heart disease.
Many dentists were perhaps concerned that if their services were included in Medicare, they would receive lower fees than if their services were only available through private insurance. The ADA is now lobbying for Medicare dental benefits — but only for low-income patients, only offered through private Medicare Advantage plans, and only if dental is included in a special part of Medicare.
Now that Congress has passed a version of President Biden’s Infrastructure bill, and has agreed to bring a “Build Back Better” bill to the floor by mid-November, the “missing parts” of Lyndon Johnson’s Medicare program are back on the operating table. Will Congress use this opportunity to complete Medicare?
The House of Representatives wants to add dental care, vision and hearing services. Vision care would include eyeglasses and contacts, plus the needed exams and fittings.
Coverage for hearing would include a hearing assessment, management of hearing loss, and related treatment as part of traditional fee-for-service Medicare. Twenty-seven million seniors today get limited hearing services through Medicare Advantage contractors, which enroll seniors in private insurance plans instead of original Medicare. But that leaves another 36 million older people in traditional Medicare without hearing care.
Congress is now considering expanding benefits for these elders to add coverage for certain hearing aids for “individuals diagnosed with moderately severe, severe, or profound hearing loss,” and a hearing aid for each ear every five years.
According to the Biden Administration, only three out of 10 seniors who need a hearing aid have ever used them. Nearly half of older Americans over 75 have trouble hearing.
In addition to dental, eye and hearing care, Congress is also wrestling with the long-proposed idea of allowing Medicare to negotiate prices with drug companies. The drug manufacturing lobby has successfully bottled up all efforts in the past to allow Medicare to use its substantial market share to lower drug costs for some of the most expensive drugs for seniors like cancer drugs, arthritis drugs, and insulin.
Under a plan now in negotiation, the federal government would select 100 of the highest-cost drugs, and chose 10 for negotiated prices in the year 2025, and 10 more drugs would be added by 2028. The bill would also place inflation price caps on prescription drug prices for all insurance plans. The maximum out-of-pocket cost for a 30-day supply of insulin would be $35 in 2023, and this benefit would not be limited to Medicare beneficiaries.
Last July, Congressman Bernie Sanders tweeted: “Vision care is health care. Dental care is health care. Hearing care is health care. That’s why we must expand Medicare to cover dental care, eyeglasses, and hearing aids.”
Readers should call the Capitol Switchboard at 202-224-3121 and ask to be connected to Congressman McGovern, Congressman Neal, Sen. Markey, or Sen. Warren. Tell them: “It’s time to Build a Better Medicare. Older Americans have eyes, teeth and ears.” Then read them Bernie Sander’s quote.
Al Norman lobbied for Massachusetts Older Americans on Beacon Hill for nearly four decades. The late Boston Mayor Thomas Menino named an honorary street ‘Al Norman Way’ to memorialize Norman’s work on behalf of the elderly.