Biden's Spending Framework Limits Medicare Expansion

Medicare benefits would be expanded to include hearing coverage under a framework for a $1.75 trillion spending plan released by President Joe Biden on Thursday.

Biden’s proposed Medicare expansion is less ambitious than some Democrats have pushed for. Currently, original Medicare doesn’t cover hearing, dental or vision benefits, and a budget reconciliation bill considered by Congress earlier this year would have expanded the program to cover all three. Proponents of the expansion argued that covering these benefits would ensure that older Americans received necessary care and would put original Medicare on a more level playing field with Medicare Advantage plans. Some Advantage plans, which are provided by private insurers, already cover dental, hearing and vision.

However, the expansion into all three areas could have been costly. Based on a 2019 bill that proposed expanding Medicare, the Congressional Budget Office estimated that covering all three areas would cost about $360 billion over a decade. Of that, $89 billion would go toward hearing care with $30 billion for vision services and $238 billion for dental care.

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Biden's framework, called Build Back Better, said that adding hearing benefits would cost $35 billion over 10 years.

Democrats had hoped to offset these increased costs by allowing Medicare to negotiate lower drug prices for expensive medications with no generic alternatives. This change was also not included in Biden’s framework.

The proposed Medicare expansion could still change significantly or the plan for adding even hearing benefits could be scrapped entirely if Congress passes legislation that differs from Biden’s framework. Right now, the related draft legislation says hearing benefits would begin in 2024 and would cover one hearing aid per ear every five years. A written order from a doctor or audiologist would also be required.

Biden’s framework also included improving Medicaid coverage for home care services for older adults and those with disabilities. The proposal touted this as the “most transformative investment in access to home care in 40 years.” Currently, Medicaid will cover some costs for home care, though the services provided varies by state.