Medicare Hearing Expansion and Vision Coverage May Reduce Health Inequities

New research shows that expanding Medicare’s vision and hearing coverage will dramatically increase access to the most vulnerable in the United States at a fraction of the cost to taxpayers.

Medicare beneficiaries with incomes below the federal poverty line spent less than half a year on vision services and nearly three times less on hearing services than their higher-income peers, according to data analysis from the City Institute. The data shows that there is a huge unmet need for glasses, hearing aids, and other related services among low-income Medicare recipients, and that these items are likely to be of lower quality.

The House of Representatives version of the Improved Condition Recovery Act will cover hearing services for Medicare members starting in 2023. However, in the latest version of the bill, policymakers have cut vision and dental services to cut costs.

“If the higher-income population is where the need for glasses, hearing aids, etc. is needed, this suggests that there is an unmet need among the lower-income population. higher income populations have higher quality frames and hearing aids, “said Anuj Gangopadhyaya, Senior Research Fellow at the Urban Institute. them – it could affect other aspects of health as well. ”

The researchers found that the costs of vision and hearing services were relatively small compared to Medicare’s total spending of $ 1.1 trillion. The Congressional Budget Office estimates that the cost of expanding hearing, visual and dental services for Medicare members will cost only $ 358 billion over 10 years.

“By progressively improving your hearing and vision coverage, you create a virtuous cycle,” said Dr. Harry Greenspan, chief physician at Guidehouse, a consulting firm. “Expanding benefits will increase costs over costs. It is also critically important that high cash spending has a disproportionate impact on people on low incomes. ”

Medicare recipients spent $ 8.4 billion on vision services in 2020, of which $ 5.4 billion were paid out of pocket by members, according to the policy note. Last year, beneficiaries spent $ 5.7 billion on hearing services, of which $ 4.7 billion was attributable.

Beneficiaries often have to choose between food, medicine and other essentials, as well as hearing aids or glasses. Although, according to experts, these trade-offs are difficult to quantify.

“Medicare’s goal as a social security program is to put both low and high income people on the same platform,” Gangopadhyaya said.

Research shows that about one in three older adults have eye conditions that reduce vision, and about half have hearing loss.

As hearing and vision deteriorate, it becomes more difficult to communicate, read and process information. Although the policy brief does not quantify the associated subsequent impacts on health outcomes and costs, hearing and vision loss can exacerbate mental health problems and reduce quality of life. Experts believe that access to more preventive services can prevent serious health complications and reduce health care costs, especially among the most vulnerable populations.

“Helping people get their glasses seems like a simple task, but it can help avoid slipping and falling that can lead to costly emergency department visits, hospital stays and longer nursing home stays,” said Gretchen Jacobson, vice president of Medicare at Commonwealth Foundation. “It is important to consider both the short and long term costs of these types of services and consider them in the context of what they will do to the federal budget and improve the well-being of the people.”

Biogen’s Alzheimer Aduhelm costs about $ 56,000 a year, though vendors question whether it works at all. Greenspan said there will be a much larger return on investment in incremental improvements in basic health coverage.

“All health outcomes are highly dependent on the ability to communicate and absorb information,” he said. “We are willing to spend trillions on drugs that have modest improvement in certain areas – and cause many side effects – but ignore the basic blocking and countering methods we can do that are far more valuable than much more expensive therapies. “

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