H.R. 2045 — Medicare Dental, Vision, and Hearing Benefit Act of 2025

This section establishes Medicare Part B coverage for dental and oral health services (as defined in new SSA §1861(nnn), i.e., (1) preventative/screening services such as oral exams, dental cleanings, x-rays, and fluoride treatments; (2) basic services such as tooth restorations, basic periodontics, tooth extractions, and oral disease management; (3) major services such as major restorations, major periodontics, bridges, crowns, root canals, and extractions; (4) emergency dental care; and (5) other necessary related services) by adding them to covered physician services under SSA §1861(s)(2)(KK) and incorporating them into payments under the physician fee schedule (§1848). It sets payments at the applicable percent of the lesser of the actual charge or the fee schedule amount: (1) 100% for preventative/screening services in 2026 and later; (2) for other services, 0% before 2027, 30% in 2027, 60% in 2028, and 80% in 2029 and later; and (3) for low-income subsidy-eligible individuals, 100% for preventative services in 2026 and later and 80% for other services in 2027 and later. (Thus, beneficiaries generally pay 100% coinsurance before 2027 except for low-income individuals' preventative services; coinsurance phases down thereafter.) It limits coverage to two routine cleanings and two exams per 12-month period and authorizes the Secretary to impose additional limitations (e.g., prior authorization), modify coverage consistent with U.S. Preventive Services Task Force recommendations, or waive frequency limits. Separately, this section expands Medicare Part B coverage of prosthetic devices under SSA §1861(s)(8) to include dentures (previously excluded); sets payments at 0% before 2027 and 80% in 2027 and later (of the otherwise applicable amount under §1834(a)); and limits coverage to one full upper denture, one full lower denture, one partial upper denture, and one partial lower denture every five years, with similar Secretarial authorities for additional limitations.

This section establishes Medicare Part B coverage for vision services (i.e., routine eye examinations and refractive procedures, plus other necessary eye and vision health services as defined by the Secretary), with payments equal to 80% of the lesser of the actual charge or the physician fee schedule amount under §1848 and limited to one routine eye exam per 12-month period. It further sets special payment rules under the durable medical equipment provisions (§1834(a)) for (1) eyeglass lenses, at 80% coinsurance up to $100 per pair every 12 months; (2) eyeglass frames, at 80% coinsurance up to $100 per set every 24 months; (3) contact lenses, at 80% coinsurance up to $200 every 24 months (with dollar limits inflation-adjusted annually from 2027 based on the consumer price index for all urban consumers); and (4) low vision devices, at 80% coinsurance. (Thus, eyewear payments exclude items covered under existing post-cataract authority in §1861(s)(8).) In all cases, the Secretary may impose additional limitations (e.g., prior authorization), modify coverage consistent with U.S. Preventive Services Task Force recommendations, or waive frequency limits.

This section establishes Medicare Part B coverage for audiology services (as defined in current law), hearing services (i.e., routine hearing exams, exams for hearing aids, and other necessary services related to hearing health as defined by the Secretary), and hearing aids (previously excluded) for services furnished on or after January 1, 2026. (1) It provides payment at 80% of the lesser of the actual charge or the physician fee schedule amount (under section 1848) for audiology and hearing services, with Secretarial authority to apply limitations (e.g., prior authorization) or modify coverage consistent with U.S. Preventive Services Task Force recommendations; (2) it classifies hearing aids as durable medical equipment with payment at 80% of the otherwise applicable amount under durable medical equipment rules, limited to one hearing aid per ear every 48 months (waivable by the Secretary), and similar Secretarial authorities for limitations or modifications.

This section adds dentures, eyeglass lenses, contact lenses, and hearing aids to the list of items excluded from competitive acquisition under Medicare Part B for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). (Thus, Medicare beneficiaries may obtain these items from any Medicare-enrolled supplier in competitive bidding areas, rather than only from contract suppliers.)

This section requires the United States Preventive Services Task Force (USPSTF)—which develops evidence-based recommendations on clinical preventive services such as screenings, counseling, and preventive medications—to include at least one oral health professional among its members. (The requirement applies beginning January 1 of the first year beginning at least six months after enactment.)