Out-of-pocket spending on dental, hearing in Medicare far outweighs vision benefits: Kaiser

 Out-of-pocket spending for hearing and dental care far outpaced spending for vision care among Medicare beneficiaries, a new analysis found.

The analysis, released Tuesday by the Kaiser Family Foundation, examines out-of-pocket spending in 2018 and 2019 on traditional Medicare and Medicare Advantage on the three benefits. It comes as Congress is contemplating adding the three benefits to traditional Medicare as part of a $3.5 trillion infrastructure package.

“While some Medicare beneficiaries have insurance that helps cover some dental, hearing, and vision expenses (such as Medicare Advantage plans), the scope of that coverage is often limited, leading many on Medicare to pay out-of-pocket or forego the help they need due to costs,” Kaiser said in the analysis.

The largest source of out-of-pocket spending was hearing care, where beneficiaries spent $914 on average in 2018, Kaiser found.

Out-of-pocket spending on dental was $874, and vision care was $230.

But dental care was by far the most used benefit, with 53% of Medicare’s beneficiaries employing it. Vision care was the second most-used benefit with 35% of beneficiaries employing the service, and hearing care was used by 8%.

Kaiser found that in 2018, a small share of beneficiaries incurred the highest out-of-pocket costs for dental and hearing care.

Half of the beneficiaries that got dental services had out-of-pocket spending below $244 in 2018 as well as $130 for vision and $60 for hearing benefits.

But a smaller share of beneficiaries incurred high out-of-pocket costs. Kaiser found that beneficiaries in the top 10% of out-of-pocket costs spent $2,136 or more for dental care, $3,600 for hearing and $585 for vision care.

The higher costs were likely tied to costly equipment like hearing aids or pricey dental procedures such as implants, Kaiser said.

Overall, beneficiaries enrolled in MA plans spent less out-of-pocket for dental and vision than traditional beneficiaries, but there was no difference in spending on hearing care.

“Both groups spent substantially more for dental and hearing services than vision services,” the analysis said. “For dental services, average out-of-pocket spending was $766 among beneficiaries in Medicare Advantage and $992 among beneficiaries in traditional Medicare.”

The analysis also found problems with some beneficiaries getting access to care.

“About one in six Medicare beneficiaries reported in 2019 that there was a time in the last year that they could not get dental, hearing or vision care, and among those who reported access problems, cost was a major barrier,” Kaiser said.

The analysis comes as Congress is debating how to add dental, vision and hearing benefits to traditional Medicare as part of a $3.5 trillion infrastructure package.

“Expanding Medicare coverage for dental, hearing and vision services and making lower-cost hearing aids available would address significant gaps in coverage and could alleviate cost concerns related to these services for people on Medicare,” Kaiser’s analysis said.

https://www.fiercehealthcare.com/payer/kff-analysis-finds-out-pocket-spending-dental-vision-medicare-far-outweighs-vision-benefits