Extending Medicare’s hearing could reduce health inequalities in facial coverage

Expanding Medicare coverage of vision and hearing services would significantly expand access to the most vulnerable U.S. residents at minimal cost to taxpayers, new research shows.

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

The version of the Build Back Better Act recently passed by the House will cover hearings for Medicare enrollees beginning in 2023. But policymakers are cutting vision and dental services in the latest draft of the bill to cut costs.

“If the higher-income population serves as 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 better quality frames and hearing aids,” said Anuj Gangopadhyaya, senior research associate for the Urban Institute. “There is a lot of association between hearing loss and health care use, quality of life and the ability to follow and listen to the questions of medical providers — it can have effects on other areas of health care as well.”

Spending on both vision and hearing services was relatively small compared to total Medicare spending of $1.1 trillion, researchers found. The cost of expanding hearing, vision and dental services for Medicare beneficiaries would cost just $358 billion in 10 years, the Congressional Budget Office estimated.

“A virtuous cycle has been created by making incremental improvements in hearing and vision coverage,” says Dr. Harry Greenspun, medical director of the consultancy Guidehouse. “Expanding benefits would deliver an inordinate amount of value relative to the expenditure. Also critically, high out-of-pocket costs disproportionately impact those on lower incomes.”

Medicare beneficiaries spent $8.4 billion on vision services in 2020, of which $5.4 billion paid out of pocket, according to the research brief. Beneficiaries spent $5.7 billion on hearing services last year, including $4.7 billion on enrollees.

Beneficiaries often have to choose between food, medicine and other supplies and hearing aids or glasses. While it’s difficult to quantify those tradeoffs, experts said.

“The goal of Medicare as a social insurance program is to place lower-income and higher-income beneficiaries on the same platform,” Gangopadhyaya said.

About one in three elderly people has an eye disease that reduces vision, and about half experience hearing loss, research shows.

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

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

Biogen’s Alzheimer’s drug Aduhelm costs about $56,000 a year, though providers have wondered if it even works. There would be a much greater return on investment in incremental improvements in health coverage for basic services, Greenspun said.

“All health outcomes are very dependent on being able to communicate and absorb information,” he said. “We’re willing to spend trillions on drugs that have a slight improvement in certain areas – and cause a lot of side effects – but ignore the basic block-and-approach things we can do that have much more value than the much more expensive therapies. “

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