Medicare Benefits Expansion Faces Health Care Industry Opposition

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Medicare Benefits Expansion Faces Health Care Industry Opposition

Plans by leaders in Congress to expand Medicare to include dental, vision, and hearing benefits are facing pushback from sectors of the health care industry, including private health insurers and dentists, as outlined in an article at Politico.

Medicare, the federal health insurance program for people ages 65 and older, is popular across the political spectrum in the United States. And while seniors rely on the program for most of their health care coverage, it has some notable gaps in covered services — the program doesn’t cover routine dental care, vision exams or glasses, or hearing exams or hearing aids. These gaps have prompted many Democrats in Congress to push to expand Medicare to cover them, and this expansion was included in the recently passed $3.5 trillion preliminary budget outline passed by both houses of Congress.

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Certain groups opposing expanded Medicare benefits

But certain interests in the health care sector are now lining up to oppose including expanded Medicare benefits in the final budget plan — including private insurance companies that stand to see a drop in their supplemental health coverage business if Medicare offers these benefits. The American Dental Association is also worried that Medicare will pay less for dental services than under the current system — a valid concern, in all likelihood — and is pushing to limit the expansion of dental benefits. In the face of this opposition, Congressional committees are considering a number of options — including phasing in benefits over a longer period of time, increasing the level of cost-sharing (deductibles and copayments) for the new benefits, and even means-testing benefits so that they apply only to lower-income seniors — something that Medicare has never done for any benefits.

When it comes to dental benefits, the American Dental Association is pushing for a generous benefit under Medicare, but only for people earning up to 300% of the federal poverty line — people who are currently unlikely to be able to pay for their dental care. While structuring the benefit this way may lead to the greatest benefit for the neediest Americans, to also conveniently means that dentists would get new patients without any reduction in payments for care given to current patients.

On the other side of the argument — pushing for widespread and generous benefits — is AARP, the interest group representing Americans age 50 and older. AARP leaders warn that if the new benefits are too skimpy or cover too few people, they won’t be politically popular and may be rescinded by a future Congress. If they’re generous and go into effect soon, the group argues, they’ll not only do the most good, but they’ll also be seen quickly as an essential part of Medicare.

America’s Health Insurance Plans, the lobbying group for the private health insurance industry, argues that expanding Medicare to cover dental, vision, and hearing benefits could limit other extra benefits offered by private Medicare Advantage plans, such as free over-the-counter drugs. The group is pressing Congress to increase its payments to private insurers that offer Medicare Advantage plans if coverage is expanded. Instead, many Democrats in Congress believe that these payments are already too high, noting that traditional Medicare is less expensive per beneficiary, and are pushing to reduce payments to private insurers as a way to help pay for the new Medicare expansion.

It remains to be seen how much sway health care industry arguments will have in the structure of Medicare benefits expansion — and the public may not know the results of these mostly behind-the-scenes discussions until a final budget bill is introduced in the House and Senate.

Want to learn more about Medicare and diabetes? Read “Medicare Rule Change May Help Expand Diabetes Prevention Programs,” “Medicare Proposes Expanding CGM Coverage,” and “Medicare Plans to Offer $35 Monthly Cap on Insulin Costs.”

Quinn Phillips

Quinn Phillips

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A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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