Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025

This legislation, known as the Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2025 , significantly expands healthcare coverage by amending titles XVIII and XIX of the Social Security Act. For Medicare beneficiaries, it introduces comprehensive coverage for dental and oral health services, including routine cleanings, exams, fillings, crowns, root canals, extractions, and emergency dental care. The bill also explicitly covers dentures, removing previous exclusions and setting specific payment rules and frequency limitations, such as one full or partial denture set every five years. The bill further extends Medicare coverage to include vision services , encompassing routine eye examinations and procedures to determine refractive states. It provides for eyeglasses, contact lenses, and low vision devices, with limitations such as one pair of eyeglass lenses every 12 months and a cap on contact lens payments. Similarly, hearing services are added, covering routine hearing exams, exams for hearing aids, and audiology services, along with coverage for hearing aids, limited to one per ear every 48 months. For all newly covered Medicare services—dental, vision, and hearing—the bill establishes a phased-in payment structure. Initially, the payment amount is 0 percent, gradually increasing by 10 percentage points annually until it reaches 80 percent in the eighth year and subsequent years. The Secretary of Health and Human Services is granted authority to apply additional reasonable limitations, including prior authorization requirements, and to modify coverage consistent with recommendations from the United States Preventive Services Task Force. The amendments for Medicare services will apply to services furnished on or after January 1 of the first year beginning at least six months after the bill's enactment. For Medicaid, the bill increases the Federal Medical Assistance Percentage (FMAP) to 90 percent for expenditures related to these new dental, vision, and hearing services. This enhanced federal funding applies to adults not already covered for these services, encouraging states to expand access to these essential benefits for their Medicaid populations.