Jesse M. Ehrenfeld, MD, MPH President | Official website
The American Medical Association (AMA) has adopted new policies aimed at expanding health care coverage, focusing on Medicaid and Medicare patients. The policies address gaps in coverage for hearing, vision, and dental services under Medicaid, as well as affordability of Medigap policies for Medicare beneficiaries.
One policy advocates for expanded Medicaid coverage to include hearing and vision services for all patients. Currently, Medicaid's coverage of these services varies significantly by state. Twenty-eight states provide some level of hearing coverage, often leaving patients unable to afford necessary aids or related services. The AMA aims to work with state medical associations to support comprehensive hearing exams, hearing aids, cochlear implants, and aural rehabilitative services.
Similarly, thirty-three states offer some form of vision coverage under Medicaid. However, access is frequently limited based on severity of impairment or other restrictions. The new AMA policy supports routine comprehensive vision exams and visual aids such as eyeglasses and contact lenses.
Dental services are another area where Medicaid coverage is inconsistent. Nineteen states offer comprehensive dental benefits while the rest provide limited or emergency-only coverage. High out-of-pocket costs lead many Medicaid patients to forego necessary dental care. Revised AMA policy encourages collaboration with the American Dental Association and other organizations to improve access to dental care for Medicare, Medicaid, and CHIP patients.
“There isn’t much logic to the fact that most Medicaid patients don’t get comprehensive coverage above the neck,” said Pratistha Koirala, M.D., PhD., a member of the AMA Board of Trustees. “Failure to address vision, hearing and dental issues not only leads to more severe health problems but also represents preventable obstacles to work and everyday life.”
In addition to addressing Medicaid concerns, the AMA has adopted a resolution aimed at making Medigap policies more affordable for Medicare patients who wish to switch from Medicare Advantage plans back to traditional Medicare. Under current regulations, individuals may face barriers when trying to enroll in Medigap plans outside a one-time six-month enrollment period protected by guaranteed issue rights.
“This guarantee is baked into the Affordable Care Act marketplaces but is not yet part of Medicare,” said Scott Ferguson, M.D., a member of the AMA Board of Trustees. “There are good reasons that patients switch to traditional Medicare, and they shouldn’t have to pay a higher cost to do so.”
The new policy supports annual open enrollment periods for Medigap plans along with guaranteed lifetime enrollment eligibility and extended modified community rating regulations.
Medigap regulations currently vary by state; some states protect against increased costs or reduced coverage when switching plans while others do not offer such protections. Additionally, current law requires Medigap plans be offered only to Medicare beneficiaries over 65 years old but not those under 65 who are on dialysis or have disabilities. The AMA will advocate for expanded access to Medigap policies for all eligible individuals regardless of age or condition.
