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      Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries : The role Medicare Advantage plans play in providing dental, vision, and hearing services to older adults, particularly among low- and middle- income beneficiaries.

      1 , 2 , 3 , 4 , 5 , 6
      Health Affairs
      Health Affairs (Project Hope)

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          Abstract

          Among Medicare beneficiaries, dental, vision, and hearing services could be characterized as high need, high cost, and low use. While Medicare does not cover most of these services, coverage has increased recently as a result of changes in state Medicaid programs and increased enrollment in Medicare Advantage (MA) plans, many of which offer these services as supplemental benefits. Using data from the 2016 Medicare Current Beneficiary Survey, this analysis shows that MA plans are filling an important gap in dental, vision, and hearing coverage, particularly among low- and middle-income beneficiaries. In 2016 only 21 percent of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas 62 percent of MA enrollees were in plans with a dental benefit. Among Medicare beneficiaries with coverage overall, out-of-pocket expenses still made up 70 percent of dental spending, 62 percent of vision spending, and 79 percent of hearing spending. While Medicare beneficiaries are enrolling in private coverage options, they are not getting adequate financial protection. This article examines these findings in the context of recent proposals in Congress to expand Medicare coverage of dental, vision, and hearing services.

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          Hearing loss and incident dementia.

          To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD). Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, 70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension. Baltimore Longitudinal Study of Aging. Six hundred thirty-nine individuals aged 36 to 90 years. Incident cases of all-cause dementia and AD until May 31, 2008. During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53). Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.
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            Prevalence of Hearing Loss by Severity in the United States.

            To estimate the age- and severity-specific prevalence of hearing impairment in the United States.
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              The association between hearing loss and social isolation in older adults.

              To determine if age-related hearing loss is associated with social isolation and whether factors such as age, gender, income, race, or hearing aid use moderated the association.
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                Author and article information

                Journal
                Health Affairs
                Health Affairs
                Health Affairs (Project Hope)
                0278-2715
                1544-5208
                February 01 2020
                February 01 2020
                : 39
                : 2
                : 297-304
                Affiliations
                [1 ]Amber Willink () is an assistant scientist in the Department of Health Policy and Management and in the Cochlear Center for Hearing and Public Health, both at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
                [2 ]Nicholas S. Reed is an assistant professor in the Department of Epidemiology and in the Cochlear Center for Hearing and Public Health, both at the Johns Hopkins Bloomberg School of Public Health.
                [3 ]Bonnielin Swenor is an associate professor in the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine.
                [4 ]Leah Leinbach an assistant professor in the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine.
                [5 ]Eva H. DuGoff is an assistant professor in the Department of Health Services Administration, School of Public Health, University of Maryland, in College Park.
                [6 ]Karen Davis is a professor emerita in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.
                Article
                10.1377/hlthaff.2019.00451
                7652597
                32011933
                79e372f8-4f2b-4511-98a1-9a98e2d580e4
                © 2020
                History

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