S. 2084: Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025

This bill introduces amendments to the Social Security Act to expand Medicare and Medicaid coverage for dental, vision, and hearing services. Here are the key provisions outlined in the bill:

Dental and Oral Health Services

• Coverage Expansion: The bill adds dental and oral health services under Medicare. This includes routine dental cleanings, exams, basic services like fillings, major services including root canals and extractions, emergency dental care, and other services as determined necessary by the Secretary of Health and Human Services.
• Payment Structure: The payments for dental services will increase gradually, starting at 0% in the first year and rising by 10 percentage points each year up to the seventh year, after which it would stabilize at 80% of the costs.
• Frequency and Limitations: There are limits on the frequency of covered services. For instance, 2 routine cleanings and exams are covered per year. The Secretary of Health and Human Services can also impose further restrictions as necessary.
• Dentures: Coverage for dentures is included with similar payment rules as dental services, also limiting the number of dentures funded by Medicare to once every five years.

Vision Services

• Coverage Expansion: Medicare will now cover vision services, defined to include routine eye examinations and necessary related procedures.
• Payment Structure: Similar to dental services, there will be a gradual increase in payment percentages, starting at 0% in the first year and reaching 80% by the eighth year.
• Limitations: Only one routine eye exam will be covered every 12 months. Additional limitations can be determined by the Secretary.

Hearing Services

• Coverage Expansion: Hearing services, including routine hearing exams and related necessary services, will be included under Medicare coverage.
• Payment Structure: Payment terms follow a similar structure to dental and vision, starting at 0% and increasing to 80% over eight years.
• Hearing Aids: The bill permits coverage for hearing aids, allowing for one hearing aid per ear every 48 months, with the same gradual payment increase provision.

Medicaid Provisions

• Increased Federal Funding: The bill specifies that Federal Medical Assistance Percentage (FMAP) for dental, vision, and hearing services under Medicaid will be increased to 90% for expenses related to these services.
• Service Definitions: The definition of Medicaid coverage will now encompass a range of dental, vision, and hearing services as outlined in the amendments.

Effective Dates

The expanded coverage provisions will take effect on January 1 of the first year that follows at least six months after the bill's enactment.

Relevant Companies

• SONY - As a producer of hearing aids and vision aids, they could see increased demand due to expanded Medicare coverage.
• DEO - Makers of dental care products may benefit from increased dental coverage for Medicare recipients.