What This Bill Does
This bill adds coverage for dental, vision, and hearing care to Medicare (a government health insurance program for people age 65 and older). It creates payment rules and limits for these services, making them available to Medicare beneficiaries (people enrolled in Medicare) starting in 2024.
Who It Affects
Medicare beneficiaries (people age 65 and older or certain younger people with disabilities enrolled in Medicare). The bill also affects the Secretary of Health and Human Services, who administers Medicare and sets payment rules.
Key Provisions
* Medicare must cover preventive and screening dental services, basic dental services, major dental services, emergency dental care, and dentures starting in 2024 (Sec. 2(g))
* Preventive dental services like cleanings and exams are covered at 100 percent; other dental services phase in coverage starting at 0 percent before 2025, reaching 80 percent by 2027 (Sec. 2(c)(2))
* Medicare must cover routine eye exams and vision-related services; beneficiaries pay 20 percent of costs (Sec. 3(c)(1)(B))
* Medicare must cover eyeglasses, contact lenses, and hearing aids with 80 percent coverage; eyeglass frames are limited to one per 24 months at no more than $100, and hearing aids are limited to one per ear every 48 months (Sec. 3(e)(24) and Sec. 4(d)(3))
* Medicare must cover audiology services and hearing exams at 80 percent coverage (Sec. 4(b))
What Changes
If this becomes law, Medicare will begin paying for dental, vision, and hearing services starting in 2024. These services were previously excluded or not covered by Medicare. Beneficiaries will receive coverage at different rates: 100 percent for preventive dental care, and 80 percent for most other dental, vision, and hearing services. The Secretary of Health and Human Services gains authority to set additional limits, require prior authorization (approval before receiving services), and adjust coverage based on recommendations from the United States Preventive Services Task Force (a federal advisory group).
Important Definitions
* Dental and oral health services: Preventive services like exams and cleanings, basic services like fillings and extractions, major services like crowns and root canals, emergency dental care, and other necessary dental services as defined by the Secretary (Sec. 2(b))
* Vision services: Routine eye exams and procedures to determine the refractive state of the eyes (whether glasses or contacts are needed), plus other necessary eye and vision health services as defined by the Secretary (Sec. 3(b))
* Hearing services: Routine hearing exams and exams for hearing aids, plus other necessary hearing health services as defined by the Secretary (Sec. 4(a)(2))
* Low vision device: A device prescribed by a physician that magnifies, enhances, or otherwise augments visual images; this excludes ordinary eyeglasses or contact lenses (Sec. 3(e)(25))
Effective Date
All dental, vision, and hearing coverage provisions take effect on January 1, 2024 (Sec. 2(g), Sec. 3(h), and Sec. 4(e)).
I
118TH CONGRESS
1ST SESSION
H. R. 33
To amend title XVIII of the Social Security Act to provide for coverage
of dental, vision, and hearing care under the Medicare program.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 9, 2023
Mr. DOGGETT (for himself, Mrs. BEATTY, Mr. BEYER, Mr. BISHOP of Geor-
gia, Mr. BLUMENAUER, Mr. BOWMAN, Ms. BUSH, Mr. CARSON, Mr. CAR-
TER of Louisiana, Mr. CARTWRIGHT, Mr. CASAR, Mr. CASTRO of Texas,
Ms. CHU, Mr. CLEAVER, Mr. COHEN, Mr. CONNOLLY, Mr. COURTNEY,
Mr. CUELLAR, Ms. DELAURO, Mr. DESAULNIER, Mrs. DINGELL, Ms.
ESCOBAR, Mr. ESPAILLAT, Mr. EVANS, Ms. LEGER FERNANDEZ, Mr.
GARAMENDI, Mr. GARCI´A of Illinois, Ms. GARCIA of Texas, Mr. VICENTE
GONZALEZ of Texas, Mr. GOTTHEIMER, Mr. GREEN of Texas, Mr. GRI-
JALVA, Mrs. HAYES, Mr. HIGGINS of New York, Ms. JACKSON LEE, Ms.
JAYAPAL, Mr. JOHNSON of Georgia, Ms. KAPTUR, Mr. KHANNA, Mr. KIM
of New Jersey, Mr. LARSON of Connecticut, Ms. LEE of California, Mr.
LIEU, Ms. MCCOLLUM, Mr. MCGOVERN, Ms. MENG, Mr. MFUME, Ms.
MOORE of Wisconsin, Mr. NADLER, Mr. NEGUSE, Mr. NORCROSS, Ms.
NORTON, Ms. OCASIO-CORTEZ, Ms. OMAR, Mr. PASCRELL, Mr. PAYNE,
Ms. PINGREE, Mr. POCAN, Ms. PORTER, Ms. PRESSLEY, Ms. BLUNT
ROCHESTER, Mr. RUIZ, Mr. RUPPERSBERGER, Ms. SCHAKOWSKY, Mr.
SCHIFF, Mr. DAVID SCOTT of Georgia, Mr. SHERMAN, Mr. SWALWELL,
Mr. TAKANO, Mr. THOMPSON of California, Ms. TITUS, Ms. TLAIB, Mr.
TONKO, Mr. TORRES of New York, Mrs. TRAHAN, Mr. TRONE, Mr.
VEASEY, Mrs. WATSON COLEMAN, and Ms. WILLIAMS of Georgia) intro-
duced the following bill; which was referred to the Committee on Energy
and Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined by the Speaker, in each case
for consideration of such provisions as fall within the jurisdiction of the
committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
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•HR 33 IH
for coverage of dental, vision, and hearing care under
the Medicare program.
Be it enacted by the Senate and House of Representa-
1
tives of the United States of America in Congress assembled,
2
SECTION 1. SHORT TITLE.
3
This Act may be cited as the ‘‘Medicare Dental, Vi-
4
sion, and Hearing Benefit Act of 2023’’.
5
SEC. 2. DENTAL AND ORAL HEALTH CARE.
6
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
7
curity Act (42 U.S.C. 1395x(s)(2)) is amended—
8
(1) in subparagraph (II), by striking ‘‘and’’
9
after the semicolon at the end;
10
(2) in subparagraph (JJ), by adding ‘‘and’’
11
after the semicolon at the end; and
12
(3) by adding at the end the following new sub-
13
paragraph:
14
‘‘(KK) dental and oral health services (as de-
15
fined in subsection (nnn));’’.
16
(b) DENTAL
AND ORAL HEALTH SERVICES DE-
17
FINED.—Section 1861 of the Social Security Act (42
18
U.S.C. 1395x) is amended by adding at the end the fol-
19
lowing new subsection:
20
‘‘Dental and Oral Health Services
21
‘‘(nnn) The term ‘dental and oral health services’
22
means—
23
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‘‘(1) preventative and screening services, such
1
as oral exams, dental cleanings, dental x-rays, and
2
fluoride treatments;
3
‘‘(2) basic dental services, such as tooth res-
4
torations, basic periodontics services, tooth extrac-
5
tions, and oral disease management services;
6
‘‘(3) major dental services, such as major tooth
7
restorations, major periodontics services, bridges,
8
crowns, root canals, and extractions;
9
‘‘(4) emergency dental care; and
10
‘‘(5) other necessary services related to dental
11
or oral health (as defined by the Secretary).’’.
12
(c) PAYMENT; COINSURANCE; AND LIMITATIONS.—
13
(1) IN GENERAL.—Section 1833(a)(1) of the
14
Social Security Act (42 U.S.C. 1395l(a)(1)) is
15
amended—
16
(A) by striking ‘‘and’’ before ‘‘(GG)’’; and
17
(B) by inserting before the semicolon at
18
the end the following: ‘‘, and (HH) with respect
19
to dental and oral health services (as defined in
20
section 1861(lll)), the amount paid shall be the
21
payment
amount
specified
under
section
22
1834(aa)’’.
23
(2) PAYMENT AND LIMITS SPECIFIED.—Section
24
1834 of the Social Security Act (42 U.S.C. 1395m)
25
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is amended by adding at the end the following new
1
subsection:
2
‘‘(aa) PAYMENT AND LIMITS FOR DENTAL AND ORAL
3
HEALTH SERVICES.—
4
‘‘(1) IN
GENERAL.—The payment amount
5
under this part for dental and oral health services
6
(as defined in section 1861(nnn)) shall be, subject to
7
paragraph (3), the applicable percent (specified in
8
paragraph (2)) of the lesser of the actual charge for
9
the services or the amount determined under the
10
payment basis determined under section 1848.
11
‘‘(2) APPLICABLE PERCENT.—
12
‘‘(A) IN GENERAL.—For purposes of para-
13
graph (1), except as provided in subparagraph
14
(B), the applicable percent specified in this
15
paragraph is—
16
‘‘(i) with respect to services described
17
in section 1861(nnn)(1) furnished during
18
2024 or a subsequent year, 100 percent;
19
and
20
‘‘(ii) with respect to services not de-
21
scribed in clause (i)—
22
‘‘(I) for a year before 2025, 0
23
percent;
24
‘‘(II) for 2025, 30 percent;
25
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•HR 33 IH
‘‘(III) for 2026, 60 percent; and
1
‘‘(IV) for 2027 and each subse-
2
quent year, 80 percent.
3
‘‘(B) SPECIAL RULE FOR CERTAIN LOW-IN-
4
COME
INDIVIDUALS.—For purposes of para-
5
graph (1), the applicable percent specified in
6
this paragraph is, with respect to services fur-
7
nished to an individual who is a subsidy eligible
8
individual (as defined in section 1860D–
9
14(a)(3)), or who would be a subsidy eligible in-
10
dividual if the individual were enrolled in a pre-
11
scription drug plan or MA–PD plan—
12
‘‘(i) with respect to services described
13
in section 1861(nnn)(1), for 2024 and
14
each subsequent year, 100 percent; and
15
‘‘(ii) with respect to services not de-
16
scribed in clause (i), for 2025 and each
17
subsequent year, 80 percent.
18
‘‘(3) LIMITATIONS AND SECRETARIAL AUTHOR-
19
ITY.—
20
‘‘(A) FREQUENCY.—With respect to dental
21
and oral health services that are—
22
‘‘(i) routine dental cleanings, payment
23
may be made under this part for only two
24
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•HR 33 IH
such cleanings during a 12-month period;
1
and
2
‘‘(ii) routine exams, payment may be
3
made under this part for only two such
4
exams during a 12-month period.
5
‘‘(B) SECRETARIAL AUTHORITY.—
6
‘‘(i) AUTHORITY
TO
APPLY
ADDI-
7
TIONAL LIMITATIONS.—The Secretary may
8
apply such other reasonable limitations on
9
the extent to which dental and oral services
10
are covered under this part, including
11
through application of a prior authoriza-
12
tion requirement.
13
‘‘(ii) AUTHORITY
TO
MODIFY
COV-
14
ERAGE.—Notwithstanding any other provi-
15
sion of this title, if the Secretary deter-
16
mines appropriate, the Secretary may mod-
17
ify the coverage under this part of dental
18
and oral health services to the extent that
19
such modification is consistent with the
20
recommendations of the United States Pre-
21
ventive Services Task Force.
22
‘‘(iii) AUTHORITY
TO
WAIVE
FRE-
23
QUENCY
LIMITATIONS.—Notwithstanding
24
subparagraph (A), the Secretary may
25
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waive any frequency limitation under such
1
subparagraph for an individual (or cat-
2
egory of individuals) if determined appro-
3
priate by the Secretary.’’.
4
(d) PAYMENT UNDER PHYSICIAN FEE SCHEDULE.—
5
Section 1848(j)(3) of the Social Security Act (42 U.S.C.
6
1395w–4(j)(3)) is amended by inserting ‘‘(2)(KK),’’ be-
7
fore ‘‘(3)’’.
8
(e) DENTURES.—
9
(1) IN
GENERAL.—Section 1861(s)(8) of the
10
Social Security Act (42 U.S.C. 1395x(s)(8)) is
11
amended—
12
(A) by striking ‘‘(other than dental)’’ and
13
inserting ‘‘(including dentures)’’; and
14
(B) by striking ‘‘internal body’’.
15
(2)
SPECIAL
PAYMENT
RULES.—Section
16
1834(a) of the Social Security Act (42 U.S.C.
17
1395m(a)) is amended by adding at the end the fol-
18
lowing new paragraph:
19
‘‘(23) PAYMENT AND LIMITS FOR DENTURES.—
20
‘‘(A) IN GENERAL.—The payment amount
21
under this part for dentures shall be, subject to
22
subparagraph (C), the applicable percent (speci-
23
fied in subparagraph (B)) of the amount other-
24
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•HR 33 IH
wise payable for such dentures under this sec-
1
tion.
2
‘‘(B) APPLICABLE
PERCENT.—For pur-
3
poses of subparagraph (A), the applicable per-
4
cent specified in this subparagraph is—
5
‘‘(i) for a year before 2025, 0 percent;
6
and
7
‘‘(ii) for 2025 and each subsequent
8
year, 80 percent.
9
‘‘(C) LIMITATIONS AND SECRETARIAL AU-
10
THORITY.—
11
‘‘(i) IN GENERAL.—Payment may be
12
made under this part for an individual
13
for—
14
‘‘(I) not more than one full upper
15
and one full lower denture once every
16
five years; and
17
‘‘(II) not more than one partial
18
upper denture and one partial lower
19
denture once every five years.
20
‘‘(ii) SECRETARIAL AUTHORITY.—
21
‘‘(I) AUTHORITY TO APPLY ADDI-
22
TIONAL LIMITATIONS.—The Secretary
23
may apply such other reasonable limi-
24
tations on the extent to which den-
25
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•HR 33 IH
tures are covered under this part, in-
1
cluding through application of a prior
2
authorization requirement.
3
‘‘(II) AUTHORITY
TO
MODIFY
4
COVERAGE.—Notwithstanding
any
5
other provision of this title, if the Sec-
6
retary determines appropriate, the
7
Secretary may modify the coverage
8
under this part of dentures to the ex-
9
tent that such modification is con-
10
sistent with the recommendations of
11
the United States Preventive Services
12
Task Force.
13
‘‘(III) AUTHORITY
TO
WAIVE
14
FREQUENCY
LIMITATIONS.—Notwith-
15
standing clause (i), the Secretary may
16
waive any frequency limitation under
17
such clause for an individual (or cat-
18
egory of individuals) if determined ap-
19
propriate by the Secretary.’’.
20
(f) REPEAL OF GROUND FOR EXCLUSION.—Section
21
1862(a) of the Social Security Act (42 U.S.C. 1395y) is
22
amended by striking paragraph (12).
23
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•HR 33 IH
(g) EFFECTIVE DATE.—The amendments made by
1
this section shall apply to services furnished on or after
2
January 1, 2024.
3
SEC. 3. VISION CARE.
4
(a) COVERAGE.—Section 1861(s)(2) of the Social Se-
5
curity Act (42 U.S.C. 1395x(s)(2)), as amended by section
6
2, is further amended—
7
(1) in subparagraph (JJ), by striking ‘‘and’’
8
after the semicolon at the end;
9
(2) in subparagraph (KK), by adding ‘‘and’’
10
after the semicolon at the end; and
11
(3) by adding at the end the following new sub-
12
paragraph:
13
‘‘(LL) vision services (as defined in subsection
14
(ooo));’’.
15
(b) VISION SERVICES DEFINED.—Section 1861 of
16
the Social Security Act (42 U.S.C. 1395x), as amended
17
by section 2, is further amended by adding at the end the
18
following new subsection:
19
‘‘Vision Services
20
‘‘(ooo) The term ‘vision services’ means—
21
‘‘(1) routine eye examinations and procedures
22
performed (during the course of any eye examina-
23
tion) to determine the refractive state of the eyes;
24
and
25
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•HR 33 IH
‘‘(2) other necessary services related to eye and
1
vision health (as defined by the Secretary).’’.
2
(c) PAYMENT; COINSURANCE; AND LIMITATIONS.—
3
(1) IN GENERAL.—Section 1833(a)(1) of the
4
Social Security Act (42 U.S.C. 1395l(a)(1)), as
5
amended by section 2, is further amended—
6
(A) by striking ‘‘and’’ before ‘‘(HH)’’; and
7
(B) by inserting before the semicolon at
8
the end the following: ‘‘, and (II) with respect
9
to vision services (as defined in section
10
1861(mmm)), the amount paid shall be the
11
payment
amount
specified
under
section
12
1834(bb)’’.
13
(2) PAYMENT AND LIMITS SPECIFIED.—Section
14
1834 of the Social Security Act (42 U.S.C. 1395m),
15
as amended by section 2, is further amended by add-
16
ing at the end the following new subsection:
17
‘‘(bb) PAYMENT
AND LIMITS
FOR VISION SERV-
18
ICES.—
19
‘‘(1) IN
GENERAL.—The payment amount
20
under this part for vision services (as defined in sec-
21
tion 1861(ooo)) shall be, subject to paragraph (2),
22
80 percent of the lesser of the actual charge for the
23
services or the amount determined under the pay-
24
ment basis determined under section 1848.
25
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‘‘(2) LIMITATIONS AND SECRETARIAL AUTHOR-
1
ITY.—
2
‘‘(A) FREQUENCY.—With respect to rou-
3
tine eye exams, payment may be made under
4
this part for only one such exam during a 12-
5
month period.
6
‘‘(B) SECRETARIAL AUTHORITY.—
7
‘‘(i) AUTHORITY
TO
APPLY
ADDI-
8
TIONAL LIMITATIONS.—The Secretary may
9
apply other reasonable limitations on the
10
extent to which vision services are covered
11
under this part, including through applica-
12
tion of a prior authorization requirement.
13
‘‘(ii) AUTHORITY
TO
MODIFY
COV-
14
ERAGE.—Notwithstanding any other provi-
15
sion of this title, if the Secretary deter-
16
mines appropriate, the Secretary may mod-
17
ify the coverage under this part of vision
18
services to the extent that such modifica-
19
tion is consistent with the recommenda-
20
tions of the United States Preventive Serv-
21
ices Task Force.
22
‘‘(iii) AUTHORITY
TO
WAIVE
FRE-
23
QUENCY
LIMITATIONS.—Notwithstanding
24
subparagraph (A), the Secretary may
25
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•HR 33 IH
waive any frequency limitation under such
1
[Text truncated for display. Full text available on Congress.gov.]