Expanding Medicare Hearing and Vision Coverage Could Reduce Health Inequalities


Expanding Medicare coverage for vision and hearing services would dramatically expand access to the most vulnerable U.S. residents at minimal cost to taxpayers, according to a new study.

Medicare recipients with incomes below the federal poverty line spent less than half a year on visual services and nearly three times less on hearing services than their higher-paying peers, according to a analysis of the Urban Institute. Data suggests that there is a large unmet need for glasses, hearing aids, and other related care among low-income Medicare beneficiaries and that these items are likely of lower quality.

The version of the Build Back Better law that the House recently passed will cover hearing services for Medicare registrants from 2023. But policymakers have cut vision and dental services in the latest version of the bill to cut back. the costs.

“If the high income population serves where the need is for glasses, hearing aids, etc., it suggests that 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 at the Urban Institute. “There is a strong correlation between hearing loss and health care use, quality of life and the ability to follow and listen to questions from health care providers. It could also have effects on other aspects of health care. “

Spending on vision and hearing services was relatively low compared to Medicare’s total spending of $ 1.1 trillion, according to the researchers. The cost of expanding hearing, vision and dental services for Medicare beneficiaries would cost just $ 358 billion over 10 years, the Congressional Budget Office has estimated.

“There is a virtuous circle created by gradually improving the coverage of hearing and vision services,” said Dr Harry Greenspun, chief medical officer of the consulting firm Guidehouse. “The expansion of benefits would produce disproportionate value for the expense. What is also of crucial importance is that the high reimbursable expenses have a disproportionate impact on those with low incomes. ”

Medicare beneficiaries spent $ 8.4 billion on vision services in 2020, of which $ 5.4 billion was paid out of pocket by registrants, according to the research file. Recipients spent $ 5.7 billion on hearing services last year, including $ 4.7 billion on registrants.

Beneficiaries often have to choose between food, medicine and other essentials and hearing aids or glasses. While it is difficult to quantify these tradeoffs, experts said.

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

According to research, about one in three older people suffer from eye disease that reduces vision and about half have hearing loss.

As hearing and vision deteriorate, it becomes more difficult to socialize, read and process information. Although the guidance note does not quantify the associated downstream impacts on health care outcomes and costs, hearing and visual loss can exacerbate mental health problems and reduce quality of life. Access to more preventive care could prevent serious health complications and reduce health spending, especially among the most vulnerable populations, experts said.

“Helping people buy glasses seems basic, but it can help prevent slips and falls that can lead to expensive emergency room visits, hospitalizations and longer nursing home stays,” said Gretchen Jacobson, vice-president. -President of Medicare at the Commonwealth Fund. “It’s important to consider the short and long term costs of these types of services and put them in the context of what they will do for the federal budget and improve the well-being of people.

Biogen’s Alzheimer’s drug Aduhelm costs around $ 56,000 a year, though vendors have questioned whether it works. There would be a much greater return on investment in incremental improvements in health care coverage for basic services, Greenspun said.

“All health outcomes are very much dependent on the ability to communicate and absorb information,” he said. “We’re willing to spend billions of dollars on drugs that have a slight improvement in some areas – and cause a lot of side effects – but ignore the basic blocking and tackling things we can do that are much more valuable. than much more expensive therapies. “

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