Democrats plan to expand Medicare hearing benefits. What can consumers expect?

President Joe Biden's mammoth domestic spending bill would add hearing benefits to the traditional Medicare program — one of three major new benefits Democrats had sought.

The Biden administration appears to have fallen short of its ambition to expand dental and vision along with hearing benefits. Sen. Bernie Sanders (I-Vt.) and other progressives have long pushed for more generous benefits for seniors. Citing the cost, Sen. Joe Manchin (D-W.Va.) opposed such expansion.

Biden and Democratic leaders in Congress pared back the scope of the new benefits after the total budget bill — which funds health care and other domestic initiatives — was whittled from a proposed $3.5 trillion to $1.75 trillion to meet demands of the party's moderates. The new hearing benefits would become available in 2023.

Democrats have little room for maneuvering on the bill. They need all 50 Democratic senators to support it and can lose only three members of the House on a vote. Those tight margins have made for difficult negotiations and boosted the ability of any one lawmaker to set terms. The progressive and moderate wings of the party have been at odds on the deal for months, and negotiations are ongoing.

Nonetheless, if the hearing proposal survives, it would be a significant change. Here are answers to questions seniors might have about the benefit.

Q: What does the plan do?

The draft legislation unveiled in the House proposes adding coverage to traditional Medicare that includes hearing assessment services, management of hearing loss and related treatment. About 36 million people are enrolled in original Medicare. Many of the private Medicare Advantage plans other seniors have opted to join already offer similar hearing services. According to the Centers for Medicare & Medicaid Services, roughly 27 million seniors are enrolled in a Medicare Advantage plan this year. CMS projects that number will increase to 29.5 million next year.

The new benefits include coverage of certain hearing aids for "individuals diagnosed with moderately severe, severe, or profound hearing loss," and allows seniors enrolled in traditional Medicare to get a hearing aid for each ear every five years. The new benefits cover devices furnished after a written order from a physician, audiologist, hearing aid professional or other clinician. The Food and Drug Administration separately has moved to make hearing aids available over the counter, in a bid to make them cheaper.

Q: Why are the benefits needed?

Research has shown that hearing loss can undermine seniors' overall quality of life, leading to loneliness, isolation, depression, anxiety, communication disorders and more. According to the Centers for Disease Control and Prevention's National Health Interview Survey, in 2019 nearly 1 in 3 people age 65 and over reported difficulty hearing even with a hearing aid. Biden administration officials said when unveiling the package last week that of seniors who could benefit from hearing aids, only 30% over age 70 have used them.

Hispanic adults 65 and up were more likely than other demographic groups to report having severe hearing problems, the survey found.

A KFF analysis from September found that the 4.6 million Medicare beneficiaries who used hearing services in 2018 paid $914 out-of-pocket on average. That figure includes seniors who receive benefits in traditional Medicare as well as people enrolled in Medicare Advantage plans.

Q: How many people would benefit?

The total is still up in the air as Democrats continue to negotiate details, but it's possible the number of beneficiaries could be in the millions. According to the National Institutes of Health, about 1 in 3 Americans ages 65 to 74 have hearing loss, and nearly half of those older than 75 have difficulty hearing.

To date, there's been an important distinction between seniors enrolled in traditional Medicare and those in Medicare Advantage plans. A research paper published by the Commonwealth Fund in February found that nearly all Medicare Advantage plans offered dental, vision and hearing benefits.

Still, even with Medicare Advantage, seniors can struggle to afford care, and what is covered varies by the plan. The KFF analysis found that seniors in Medicare Advantage plans spent less out-of-pocket for dental and vision care than traditional Medicare enrollees in 2018, but there was no difference in spending on hearing care.

Q: Will dental and vision benefits be added?

Leaving dental and vision benefits on the cutting room floor will disappoint progressive lawmakers.

"In Vermont and all over this country, you've got senior citizens whose teeth are rotting in their mouth, older people who can't talk to their grandchildren because they can't hear them because they can't afford a hearing aid, and people can't read a newspaper because they can't afford glasses," Sanders said on NBC earlier this year. "So to say that dental care and hearing aids and eyeglasses should be a part of Medicare makes all the sense in the world."

According to KFF, the 31.3 million Medicare beneficiaries who needed dental services in 2018 paid $874 out-of-pocket on average. The 20.3 million who needed vision care spent $230.