Expanding Medicare’s hearing, vision coverage could reduce health inequities

Broadening Medicare coverage of vision and hearing services would significantly expand access to the most vulnerable U.S. residents at minimal cost to taxpayers, new research shows.

Medicare beneficiaries with incomes below the federal poverty level spent less than half per year on vision services and nearly three times as less on hearing services than their higher-earning peers, according to an analysis from the Urban Institute. The data suggest that there is a vast unmet need for glasses, hearing aids and other related care among low-income Medicare beneficiaries and that those items are likely lower quality.

The version of the Build Back Better Act that the House recently passed will cover hearing services for Medicare enrollees starting in 2023. But policymakers cut vision and dental services in the latest iteration of the bill to reduce costs.

“If the higher-income population serves as where the need is regarding eyeglasses, hearing aids, etc., it suggests there is an unmet need among the low-income population. The spending gap also suggests that the higher-income population has better quality frames and hearing aids,” said Anuj Gangopadhyaya, senior research associate for the Urban Institute. “There is a lot of correlation between hearing loss and the use of healthcare, quality of life and the ability to follow and listen to medical providers’ questions—it could have effects on other parts of healthcare as well.”

Spending on both vision and hearing services was relatively small compared to total Medicare expenditures of $1.1 trillion, researchers found. The cost of expanding hearing, vision and dental services for Medicare beneficiaries would cost only $358 billion over 10 years, the Congressional Budget Office estimated.

“There is a virtuous cycle created by making incremental coverage improvements in hearing and vision services,” said Dr. Harry Greenspun, chief medical officer of the consultancy Guidehouse. “Expanding benefits would produce an outsized amount of value relative to the expenditure. What is also critically important is that high out-of-pocket costs have a disproportionate impact on lower-income individuals.”

Medicare beneficiaries spent $8.4 billion on vision services in 2020, $5.4 billion of which enrollees paid for out of pocket, according to the research brief. Beneficiaries spent $5.7 billion on hearing services last year, $4.7 billion of which fell on enrollees.

Beneficiaries often have to choose between food, medication and other necessities and hearing aids or eye-wear. Although it’s hard to quantify those trade-offs, experts said.

“The purpose of Medicare as a social insurance program is to put lower-income and higher-income beneficiaries on the same platform,” Gangopadhyaya said.

As hearing and vision deteriorates, it becomes harder to socialize, read and process information. While the policy brief does not quantify the associated downstream impacts on healthcare outcomes and costs, hearing and vision loss can compound mental health issues and reduce quality of life. Access to more preventative care could stave off serious health complications and reduce healthcare spending, particularly among the most vulnerable populations, experts said.

Meanwhile, Biogen’s Alzheimer’s drug Aduhelm costs about $56,000 a year even though providers have questioned whether it even works. There would be a much bigger return on investment in incremental improvements in healthcare coverage for basic services, Greenspun said.

“All health outcomes are very dependent on being able to communicate and take in information,” he said. “We’re willing to spend trillions on drugs that have mild improvement in certain areas—and cause many side effects—but ignore the basic block-and-tackle things we can do that show a lot more value than the much more expensive therapeutics.”