Vision and Hearing Care Are Essential to Seniors’ Health, but Many Believe They Don’t Need It

Untreated vision and hearing problems in older people may increase the risk of falls, social isolation, and depression, and may contribute to a poor quality of life. Timely access to vision services (e.g., eye exams and corrective lenses) and hearing services (e.g., audiological exams and hearing aids) can help mitigate or avoid these consequences.

More than 90 percent of Medicare Advantage (MA) plans provide coverage of at least some vision and hearing services; these are not covered by traditional Medicare (TM). Beneficiaries who choose to remain in TM must generally purchase separate vision and hearing policies or pay directly for these services. For the subset of beneficiaries that meet eligibility criteria, vision and hearing services may also be available through the Medicaid program. However, Medicaid coverage of vision and hearing services varies widely. For example, some states provide no coverage, while others offer examinations but not corrective eyewear or hearing aids. States also differ in the number of services a beneficiary can get per year.

Prior research has shown that a significant proportion of Medicare beneficiaries under age 65 in both TM and MA did not have coverage and did not utilize vision and hearing services. In this analysis, we use data from the Commonwealth Fund 2023 Health Care Affordability Survey to examine the extent to which Medicare beneficiaries age 65 and older have coverage for these services and if cost affects their use of services.

Medicare Advantage Beneficiaries More Likely Than Those in Traditional Medicare to Have Vision and Hearing Coverage

Among Medicare beneficiaries 65 and older, those enrolled in MA plans are substantially more likely than those in TM to report having coverage for vision and hearing services. Approximately 84 percent of MA beneficiaries report having some vision coverage, compared to only 54 percent of those in TM. Similarly, more than half of MA beneficiaries report having hearing coverage, compared to about a quarter of those in TM. Given that most MA plans offer at least some vision and hearing benefits, this finding is not unexpected.

Most Medicare Beneficiaries Received Vision Care, but Few Received Hearing Care

Most Medicare beneficiaries reported receiving vision care in the prior two-year period, including 72 percent of beneficiaries without vision coverage as well as between 80 percent and 85 percent of beneficiaries in TM and MA with coverage. In contrast, only a relatively small proportion of beneficiaries — one-third of beneficiaries in TM and one-quarter of beneficiaries in MA — reported receiving hearing services.

Medicare Beneficiaries Do Not Think They Need Vision and Hearing Services

Regardless of whether they had coverage for vision services, over half of beneficiaries reported that they did not receive vision care in the prior two years because they believed it was not needed. Similarly, most beneficiaries — about 90 percent — who did not receive hearing care reported these services were not needed.

A smaller but not insignificant proportion of beneficiaries who did not seek vision care, including one-fifth of MA beneficiaries with coverage and one-fourth of MA and TM beneficiaries without coverage, reported that they did not seek vision care because it was unaffordable. A substantially smaller proportion of TM beneficiaries (5%) cited cost as a barrier to vision care. This could reflect the fact that TM beneficiaries tend to have higher average incomes than those enrolled in MA.

Only a small proportion of beneficiaries who reported they did not use hearing services — 8 percent of those without hearing coverage and between 2 percent and 3 percent of those with coverage — reported that hearing services were unaffordable.

Findings from the survey show that use of vision and hearing services is driven by access to coverage and perceptions of need. Elderly beneficiaries may not receive necessary vision and hearing care, despite having coverage for these services, if they do not perceive such care as essential. The extent to which beneficiaries accurately assess the need for these supplemental services is unclear. Some guidelines recommend that adults age 65 and older be tested for vision loss on an annual basis and for hearing loss every one to three years. In addition, given the link between vision and hearing and health and well-being, Medicare may want to encourage the use of services, for example, by offering voluntary supplemental coverage, as well as increasing beneficiaries’ awareness of the availability of these services through the MA program.