S. 939 — Medicare Dental, Hearing, and Vision Expansion Act of 2025

This section establishes Medicare Part B coverage for dental and oral health services (as defined in new Section 1861(nnn)) furnished by a doctor of dental surgery or dental medicine or an oral health professional on or after January 1, 2027 (or January 1, 2026, for dentures). Such services include (1) preventive and screening services (i.e., oral exams, dental cleanings, dental x-rays, and fluoride treatments); (2) procedures and treatment services (i.e., fillings, bridges, crowns, root canals, periodontal maintenance and scaling, tooth extractions, therapeutic pulpotomy, and related services); and (3) dentures and dental prosthetics (i.e., complete and partial dentures and implants), excluding services permissible under current Section 1862(a)(12) and nonessential cosmetic services. This section sets Medicare Part B payment for such services at 80 percent coinsurance (or 100 percent for preventive and screening services) of the lesser of the actual charge or a fee schedule amount, with oral health professionals paid at 85 percent of the dentist fee schedule amount. The Secretary must establish the fee schedule for 2027 (or 2026 for dentures) and subsequent years at 70 percent of the national median fee from the 2020 American Dental Association Survey of Dental Fees (updated annually by the CPI-U for all urban consumers through June of the prior year, reduced by a productivity adjustment, and adjusted geographically under the physician fee schedule).

This section expands the definition of Medicare Part B audiology services under section 1861(ll) to include, beginning January 1, 2027, hearing aid examination services and treatment services (i.e., aural rehabilitation, vestibular rehabilitation, and cerumen management) furnished by qualified audiologists, and hearing aid examination services furnished by qualified hearing aid professionals (i.e., state-licensed hearing aid dispensers, specialists, or instrument dispensers who are nationally accredited or meet Secretary-determined standards); removes the physician order requirement for audiology services; and authorizes direct payment to these professionals on an assignment-related basis. The section further establishes payment under the physician fee schedule for hearing aid examination services furnished by qualified hearing aid professionals at 80% of the lesser of the actual charge or 85% of the fee schedule amount (with no prior amounts specified). This section includes hearing aids as prosthetic devices under Medicare Part B for individuals with moderately severe, severe, or profound hearing loss beginning January 1, 2027, subject to limitations including (1) coverage once per ear every five years, (2) only for Secretary-determined appropriate types, (3) pursuant to a written order from a physician, qualified audiologist, qualified hearing aid professional, physician assistant, nurse practitioner, or clinical nurse specialist, and (4) payment only on an assignment-related basis with a payment rate not exceeding a Secretary-determined amount. (Thus, Medicare beneficiaries meeting these criteria gain new coverage for hearing aids previously excluded as non-covered routine care.)

This section provides Medicare Part B coverage for vision services, defined as routine eye examinations to determine the refractive state of the eyes (including related procedures), furnished on or after January 1, 2027, by or under the supervision of an authorized ophthalmologist or optometrist. It limits such coverage to one examination per two-year period and pays for these services under the physician fee schedule. This section also expands Medicare Part B coverage for conventional eyeglasses to include one pair per two-year period on or after January 1, 2027 (previously limited to one pair post-cataract surgery with intraocular lens), with an exception allowing one pair post-cataract surgery in each period; caps payment at the 2021 Federal Supply Schedule rate (updated annually); excludes deluxe eyeglasses and conventional reading glasses; and subjects eyeglasses to competitive acquisition beginning no later than January 1, 2030. It further excludes from coverage vision services furnished more frequently than once every two years and modifies the existing exclusion for routine eye exams to exempt those covered as vision services.

This section establishes a special rule requiring the Secretary, for Medicare Part B enrollees age 65 and older in calendar years 2026 through 2030, to determine an alternative monthly actuarial rate that partially excludes the estimated costs of dental and oral health coverage added by section 2—in lieu of the full actuarial rate—for purposes of calculating monthly premiums (generally 50% of actuarial costs, with the federal government covering the rest), annual deductibles, premium subsidies, and monthly premium adjustments. (1) For 2026 and 2027, the alternative rate equals the full actuarial rate computed as if the dental coverage amendments did not apply; (2) for 2028 through 2030, it equals that rate plus 25% (2028), 50% (2029), or 75% (2030) of the difference between the full rate (including dental costs) and the rate excluding such costs. (Thus, this phases in premium increases attributable to dental coverage over five years rather than applying them fully upon implementation.)