PUBLISHED MON, OCT 28 20193:57 PM EDTUPDATED MON, OCT 28
20196:32 PM EDT
KEY
POINTS
·
Right now, Medicare’s
60 million beneficiaries can only get dental, vision and hearing coverage
through supplemental options such as Advantage plans or standalone insurance
policies.
·
Original Medicare —
Part A hospital coverage and Part B outpatient care — excludes those services
except in limited circumstances.
·
Allowing Medicare to
negotiate with drugmakers as outlined in one of the bills would save the
government $345 billion from 2023 through 2029, according to an estimate from
the Congressional Budget Office.
Medicare beneficiaries would get dental, vision
and hearing coverage if several bills now before Congress pass.
In addition, the government would get authority
to negotiate prices with drugmakers and create a cap for Medicare out-of-pocket
spending on prescription drugs. All have cleared the necessary committees over
the last couple of weeks and now await full House action.
“There have been proposals over the years that
would do this, but in the past they haven’t gone anywhere,” said David
Lipschutz, associate director at the Center for Medicare Advocacy. “It looks
like this time something could get passed in at least one chamber of Congress.”
The bills (summarized further below) are
generally supported by Democrats and opposed by Republicans. This means that
even if the measures get approved in the Democrat-controlled House, they would
would face an uphill battle in the Republican-dominated Senate.
Roughly 10,000 baby boomers turn 65 each day and
can sign up for Medicare. While the program’s 60 million beneficiaries can
access dental, vision and hearing through supplemental options such as
Advantage plans or standalone insurance policies, original Medicare — Part A
hospital coverage and Part B outpatient coverage — excludes them except in
limited circumstances.
Some of the Advantage plans now include
comprehensive dental coverage as part of the plan or as an optional
supplemental benefit, said Elizabeth Gavino, founder of Lewin & Gavino in
New York and an independent broker and general agent for Medicare plans.
However, those benefits also might be limited to
the carrier’s dental network or require prior authorization that the treatment
is medically necessary, Gavino said.
H.R. 3: Includes provisions to allow the Medicare program to
negotiate with drugmakers, cap out-of-pocket spending by beneficiaries on
prescriptions at $2,000 and expand the low-income subsidy program, which helps
cover Part D premiums and out-of-pocket costs.
H.R. 4650: Would add preventive and screening dental services,
including oral exams and cleanings under Part B. It would also cover procedures
such as tooth restorations and extractions, bridges, crowns, root canal
treatments and implants and dentures. Beneficiaries would chip in the standard
20% for basic treatments and 50% for major treatments.
H.R. 4665: Would add routine eye exams to coverage through Part B, with
beneficiaries generally paying 20% of the cost. It also would provide some
coverage — $100 — toward contact lenses or eye glasses.
H.R. 4618: Would provide coverage under Part B for hearing exams and
hearing aids, with beneficiaries contributing 20%.
This expanded coverage also might come with a
cost. While some Advantage plans have no premium, the average is expected to be
$23 in 2020, according to the Kaiser Family Foundation. Although down from $27
this year, any amount paid for a premium is on top of what Medicare enrollees
pay for Part B: $135.50 is the standard for 2019 and forecast to be $144.30
next year. (Higher earners pay more).
Roughly 22.2 million, or 37%, of Medicare
beneficiaries have Advantage plans. The remainder stick with original Medicare,
which they can pair with a supplemental policy (i.e., Medigap) and a standalone
Part D plan for prescription drug coverage (which also is typically included
with Advantage plans).
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