Medicare Poised for Major Expansion: Bill Proposes Adding Dental, Hearing, and Vision Coverage Starting 2027

A new piece of legislation, the "Medicare Dental, Hearing, and Vision Expansion Act of 2025," proposes a significant update to Medicare Part B by adding coverage for dental, hearing, and vision services. If enacted, these benefits would kick in starting January 1, 2027, aiming to fill long-standing gaps in coverage for millions of beneficiaries.

What's on the Table: A Look at New Coverage

This bill outlines specific services that would become part of Medicare:

• Dental Care (Sec. 2): Coverage includes preventive services like exams (up to 2/year), cleanings (up to 2/year), x-rays (full mouth series every 3 years), and fluoride treatments (1/year). It also covers treatments for oral diseases such as fillings, root canals, extractions, bridges, crowns, and even dentures and implants. Purely cosmetic services remain excluded. Medicare would generally pay 80% of the cost based on a fee schedule (or 100% for preventive care). This fee schedule is set at 70% of the national median fee for each service.
• Hearing Care (Sec. 3): The proposal covers hearing exams, balance assessments, and related treatments by audiologists or qualified hearing aid professionals. Importantly, beneficiaries could access audiologists directly without needing a physician referral. Hearing aids themselves would be covered for those with moderately severe to profound hearing loss, limited to one aid per ear every five years. Payment for aids is capped based on 2021 federal rates, adjusted for inflation.
• Vision Care (Sec. 4): Routine eye exams to check vision and determine refractive state would be covered once every two years. Basic, conventional eyeglasses (not deluxe frames or standard reading glasses) would also be covered, limited to one pair every two years. Like hearing aids, payment for glasses is capped based on 2021 federal rates, adjusted for inflation.

Paying the Bill: Costs, Caps, and Competition

For most covered services (excluding preventive dental), Medicare would pay 80% of the amount set by a fee schedule, leaving beneficiaries responsible for the remaining 20% coinsurance, similar to other Part B services. However, hearing aids and eyeglasses have specific payment caps tied to 2021 rates from the Federal Supply Schedule, which will be adjusted for inflation over time (Sec. 3, Sec. 4).

The bill also introduces "competitive acquisition" programs – essentially competitive bidding – for eyeglasses (starting by Jan 1, 2030) and hearing aids (starting by Jan 1, 2031). This means suppliers would compete to provide these items, potentially lowering costs for Medicare and beneficiaries, but it could also influence product selection and availability.

The Rollout and the Premium Question

While coverage begins in 2027, the full impact on Medicare Part B premiums is intentionally delayed (Sec. 5). Premiums for 2026 and 2027 won't reflect the costs of these new benefits. Starting in 2028, the cost will be gradually phased in: 25% of the added cost in 2028, 50% in 2029, and 75% in 2030. The full cost impact will hit premiums from 2031 onwards. The government has allocated specific funds ($900 million for dental, $370 million for hearing, $500 million for vision) to manage the implementation through the mid-2030s.

Real-World Ripple Effects

This expansion could be a game-changer for many Medicare beneficiaries who currently pay entirely out-of-pocket for routine dental, vision, and hearing care. Imagine a retiree needing new dentures or hearing aids – this bill could substantially lower their costs compared to today. Providers like dentists, audiologists, and optometrists would gain the ability to bill Medicare directly, potentially expanding their patient base, especially those in designated health professional shortage areas who get a 10% payment bonus (Sec. 2). However, the established fee schedules and future competitive bidding might impact provider revenues. Beneficiaries should also note the frequency limits (e.g., one pair of glasses every two years) and coverage specifics (e.g., only "conventional" eyeglasses), which mean some needs might still require out-of-pocket spending or supplemental insurance.