Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025

Expanded Dental Coverage under Medicare: The bill includes coverage for routine cleanings, exams, basic services like fillings and crowns, major services such as root canals and extractions, and emergency dental care (Section 2(b)).

Coverage for Dentures under Medicare: Medicare coverage would be expanded to include dentures, including specific rules for full and partial dentures (Section 2(e)).

Expanded Vision Coverage under Medicare: The bill provides for coverage of routine eye examinations, procedures to determine refractive state, and other necessary services (Section 3(b)).

Eyewear and Low Vision Support under Medicare: Coverage is extended to include eyeglass lenses, eyeglass frames, contact lenses, and low vision devices (Section 3(e)).

Expanded Hearing Coverage under Medicare: The bill includes coverage for audiology services, routine hearing exams, and exams for hearing aids (Section 4(a)).

Hearing Aid Support under Medicare: Coverage is provided for hearing aids, including specific limits on frequency (Section 4(d)).

Increased Medicaid Funding: The bill sets the Federal medical assistance percentage to 90 percent for expenditures by a State for certain dental, vision, and hearing services (Section 5(b)(1)).

Delayed Full Coverage under Medicare: For dental, vision, and hearing services, the applicable payment percentage starts at 0 percent for the first year after the effective date, increasing by 10 percentage points annually until it reaches 80 percent in the eighth year (Sections 2(c), 3(c), and 4(b)).

Limitations on Dental Cleanings and Exams: Under Medicare, payment for routine dental cleanings and routine exams is limited to two of each during a 12-month period (Section 2(c)(3)(A)).

Restrictions on Eyewear under Medicare: Coverage for eyeglass lenses is limited to one pair during a 12-month period, while eyeglass frames are limited to one set every 24 months (Section 3(c)(3)(C)(i)).

Contact Lens Spending Cap under Medicare: Payments for contact lenses are subject to a $200 limitation during any 24-month period (Section 3(c)(3)(C)(i)).

Limitations on Dentures under Medicare: Individuals may only receive payment for no more than one full upper and one full lower denture once every five years, or one partial upper and one partial lower denture once every five years (Section 2(e)(3)(C)(i)).

Hearing Aid Frequency Limits under Medicare: Payment may be made for no more than one hearing aid per ear during a 48-month period (Section 4(d)(3)(C)(i)).

Secretarial Authority to Limit Coverage: The Secretary has the authority to apply additional limitations, such as prior authorization requirements, on dental, vision, and hearing services (Sections 2(c), 3(c), and 4(b)).

Medicaid Eligibility Restrictions: The increased FMAP for dental, vision, and hearing services under Medicaid does not apply to individuals under the age of 21 who are eligible for specific medical assistance (Section 5(b)(2)(B)).