Means testing is the wrong approach to Medicare expansion

The debate over Medicare expansion has hurled a bad idea back into the public square:  means-testing seniors’ health care benefits. This is something seniors’ advocates have long opposed, because it would hurt beneficiaries and undermine support for the Medicare program itself. Means-testing benefits should have no role in the expansion of Medicare to include dental, vision, and hearing coverage — which are part of President Biden’s Build Back Better Plan working its way through Congress.  

These expanded coverages would plug a gaping hole in Medicare that has prevented millions of seniors from obtaining proper care for their eyes, ears, and teeth — the gateways to good health. But now some centrist members of Congress want to limit those crucial, new coverages to an income-restricted segment of beneficiaries. That amounts to means testing of benefits — something that has been anathema to Medicare since its inception.

The American Dental Association (ADA) has promoted this idea, fearing that dentists will lose money treating Medicare patients with new dental benefits. That is a questionable concern, since dentists presumably would enjoy a significantly higher volume of patients — even if Medicare fees are somewhat lower than what they’re normally paid. Also, many dentists already accept private insurance with pre-negotiated fees that are less than ‘retail,’ because it expands their patient base. 

Nevertheless, the ADA persists in advocating means testing. It wants Congress to limit the new dental benefit to seniors with annual incomes around $39,000 and below. There’s no question that the poorest of the elderly badly need dental coverage. But means-testing this benefit would exclude millions of working- and middle-class seniors who also cannot afford routine dental care. Seventy percent of Medicare patients who had trouble eating because of their teeth did not go to the dentist in the past year. More than one in ten Medicare beneficiaries said they couldn’t access dental care because of cost.  

The same applies to hearing and vision care. With the cost of hearing aids averaging more than $2,500 — and the cost of a vision exam and eyeglasses in the ballpark of $250 to $500 — many seniors simply forgo proper care. Neglecting basic dental, vision, and hearing care can have harmful health consequences, including elevated risks of serious and fatal injury and chronic disease. These health complications are not only bad for seniors; they can increase Medicare’s costs in the long run.  

Medicare beneficiaries with incomes exceeding $39,000 per year should not be locked out of new benefits because some members of Congress see only figures on a ledger rather than seniors in genuine need. The majority of older people live on fixed incomes. Their month-to-month expenses can rise sharply with scant notice. (Look what’s happened to basic costs like fuel, groceries, and housing during the pandemic.)  According to Health Affairs, one in five of today’s middle-class seniors will need costly long-term care within the next decade. How will they afford dental, hearing, and vision care on top of these and other aging-related expenses?

When Medicare was created in 1965, President Lyndon B. Johnson strongly opposed means testing because he wanted his signature program to be a universal benefit, not another form of welfare. But while benefits have never been means-tested, premiums are. (Higher earners pay higher Medicare Parts B and D premiums than lower income individuals do.)  Benefits are equal for everyone on traditional Medicare, regardless of income — an idea that is fundamental to the program’s success.  

If mean-testing results in Medicare becoming increasingly unfair to higher-income beneficiaries, they may opt out and purchase their own policy on the private market. The departure of higher-income beneficiaries, who tend to be younger and healthier, would weaken the risk pool, putting additional strain on Medicare’s finances. Not to mention that means testing new benefits could be the ‘camel’s nose under the tent’ for means-testing all benefits in the future.  

Seniors have been waiting long enough for dental, vision, and hearing coverage. Now that Congress is finally poised to expand the program, lawmakers must ensure that any new benefits are available to everyone on Medicare. That’s how Medicare has worked since its enactment 56 years ago — and how it became one of the most popular and successful federal programs. By no means does means testing of benefits have any place in Medicare.

Max Richtman is president and CEO of the National Committee to Preserve Social Security and Medicare in Washington, D.C.