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

This section adds dental and oral health services—defined to include routine cleanings and exams (limited to two each per 12-month period), basic services such as fillings and crowns, major services such as root canals and extractions, emergency dental care, and other necessary services as defined by the Secretary—to the list of Medicare Part B covered services (i.e., under 1861(s)(2) as new subparagraph (KK)); repeals the statutory exclusion for dental services (1862(a)(12)); and includes such services (and dentures) under the Medicare physician fee schedule (1848). The section establishes payment for these services at the applicable percent of the lesser of the actual charge or the physician fee schedule amount, phasing in from 0% in the first year (beginning at least six months after enactment) to 80% in the eighth year and subsequent years (increasing by 10 percentage points annually); applies a parallel phase-in and limits for dentures (e.g., one full upper and one full lower, or one partial upper and one partial lower, every five years); and authorizes the Secretary to impose additional limitations (e.g., prior authorization) or modify coverage consistent with United States Preventive Services Task Force recommendations. The amendments apply to services furnished on or after January 1 of the first year beginning at least six months after enactment.

This section establishes Medicare Part B coverage for vision services, defined as routine eye examinations and procedures to determine refractive error and other necessary services related to eye and vision health (as defined by the Secretary), with payments equal to a phase-in percentage of the lesser of the actual charge or the physician fee schedule amount under section 1848—from 0% in the first year (beginning at least six months after enactment), increasing by 10 percentage points annually through the seventh year, to 80% in the eighth year and thereafter. (As background, Medicare Part B covers 80% of reasonable charges for outpatient services such as physician visits, but previously excluded routine vision care.) It limits coverage to one routine eye exam per 12-month period and authorizes the Secretary to impose additional limitations (e.g., prior authorization) or modify coverage consistent with U.S. Preventive Services Task Force recommendations. The section also establishes phased-in payments (0% to 80% over eight years, as described above) under durable medical equipment rules for eyeglass lenses (one pair per 12 months), eyeglass frames (one set per 24 months), and contact lenses (up to $200 per 24 months, adjusted annually for inflation thereafter), with comparable Secretarial authorities.

This section establishes Medicare Part B coverage for hearing services (i.e., routine hearing exams and exams for hearing aids; other necessary services related to hearing health, as defined by the Secretary), alongside audiology services, with payments equal to a phased-in applicable percent—from 0% in the first year (beginning at least six months after enactment) to 80% by the eighth year and thereafter—of the lesser of the actual charge or the physician fee schedule amount under Medicare physician fee schedule (PFS); includes these services under the PFS; and authorizes the Secretary to impose limitations (e.g., prior authorization) or modify coverage consistent with U.S. Preventive Services Task Force recommendations. This section further includes hearing aids as durable medical equipment; repeals their prior exclusion from coverage; applies similar phased-in payments (0% to 80% over eight years); limits coverage to one hearing aid per ear every 48 months; and authorizes the Secretary to impose additional limitations (e.g., prior authorization, minimum hearing loss criteria) or modify coverage consistent with U.S. Preventive Services Task Force recommendations.

This section (1) revises the definition of dental services under Medicaid to include any dental and oral health service (as defined in Medicare section 1861(nnn)); (2) adds to paragraph (13) of such definition any vision service (as defined in Medicare section 1861(ooo)) or hearing service (as defined in Medicare section 1861(ll)(5)); and (3) establishes a 90 percent Federal medical assistance percentage (FMAP) for state Medicaid expenditures for dental and oral health services, vision services, and hearing services furnished on or after January 1 of the first calendar year beginning at least six months after enactment, excluding such services furnished to individuals under age 21 eligible for early and periodic screening, diagnostic, and treatment (EPSDT) services under subsection (a)(4)(B). (As background, Medicaid is a joint federal-state program providing health coverage to low-income individuals, families, pregnant women, children, elderly adults, and people with disabilities; dental, vision, and hearing services are generally optional for adults but mandatory under EPSDT for those under 21.)