Cost Considerations Limit Access to Dental, Vision, and Hearing Services for Under-65 Medicare Beneficiaries

Although the generosity of plans differ, the majority of Medicare Advantage (MA) plans offer enrollees access to supplemental services that typically include benefits like dental, vision, and hearing services. Traditional Medicare generally does not cover non-medically necessary dental services, eyeglasses or other vision care, or hearing services. Some low-income Medicare beneficiaries have coverage for these services through Medicaid, which varies by state. Some beneficiaries have retiree coverage through former employers or unions, and other beneficiaries may choose to purchase coverage from private insurers.

Despite the importance of these services to beneficiaries’ overall health and well-being, little is known about the extent to which beneficiaries in traditional Medicare and MA utilize these services and the degree to which costs affect use of these services. Using the Commonwealth Fund 2023 Health Care Affordability Survey, we looked at the use and affordability of these services among Medicare beneficiaries under age 65. This population, which accounts for about 13 percent of all Medicare-eligible beneficiaries, qualifies for Medicare on the basis of disability or a qualifying condition.

About 60 Percent of Under-65 Beneficiaries in Traditional Medicare Report Having Coverage for Dental and Visions Services

Overall, beneficiaries in traditional Medicare were less likely to report they had coverage for dental, vision, or hearing coverage. Slightly more than 80 percent of MA enrollees reported having dental and vision coverage, compared to about 60 percent of beneficiaries in traditional Medicare. Substantially fewer beneficiaries, 36 percent of those in traditional Medicare and 58 percent of those in MA, reported being covered for hearing services.

Comparable Proportions of Under-65 Beneficiaries in Traditional Medicare and MA Reported Using Dental and Vision Services.

Survey respondents were asked whether they had used any dental, vision, or hearing services in the previous two years. Respondents who reported they did not have coverage for these services were substantially less likely than those with coverage to have received services. Among those with coverage, comparable proportions of beneficiaries in traditional Medicare and MA, about two-thirds, reported they used dental services in the prior two years. Similarly, the two groups were equally likely (about three-quarters of respondents) to indicate they had used vision services during that time. Only one-quarter of those in traditional Medicare and one-third of those in MA received hearing services in the prior two years.

Among People Without Coverage, Cost Is Primary Reason for Not Obtaining Dental or Vision Care

Most beneficiaries without dental (62%) or vision (53%) coverage who reported they had not received these services said they did not use these services because costs were unaffordable. Although cost was a less-limiting factor for those with dental or vision coverage, nearly one of five beneficiaries in an MA plan or in traditional Medicare still reported they did not receive dental services due to the cost of care. Moreover, one of four MA enrollees and one of 10 traditional Medicare beneficiaries with vision coverage did not receive vision services because of the cost (this difference is not statistically significant). Among those with and without hearing coverage, lack of need was cited as the primary factor for not obtaining hearing services (data not shown).

Findings

Regardless of whether in traditional Medicare or Medicare Advantage, a large proportion of beneficiaries under age 65 do not have dental, vision, or hearing coverage. That beneficiaries in traditional Medicare are less likely than beneficiaries in MA to have coverage is not surprising given that these services are not Medicare-covered benefits. Moreover, the cost to purchase standalone insurance could be prohibitive for beneficiaries under age 65, many of whom have low incomes due to disabilities or health conditions that prevent them from working full time.

Lacking coverage puts cost burden squarely on patients. However, findings also show that even among people with coverage, costs of care limited access for a substantial proportion of beneficiaries under age 65 in both traditional Medicare and MA.

Plans that cover dental, vision, and hearing services vary widely in terms of covered services and out-of-pocket costs. For instance, while most dental benefits offered by MA plans provide coverage of preventive services, including X-rays and cleanings, fewer cover restorative services, endodontics, or dentures. Plans also may have low annual maximum limits (across MA plans, an average of $1,300 in 2021) and copayments that may exceed 50 percent for restorative care, extractions, and other nonpreventive services. Limitations in covered services and high out-of-pocket costs may make dental, vision, and hearing care unaffordable even for those who are insured.

Policymakers continue to debate the merits of expanding covered benefits under traditional Medicare to enhance access to services that are critical to health and well-being. As policies are evaluated, we should also consider standardizing these benefits. For beneficiaries in MA plans, in particular, standardizing benefits to ensure the set of services (e.g., preventive and restorative dental services) and beneficiaries’ cost sharing are uniform across plans would help beneficiaries select plans that best meet their needs.