Casey bill urges Medicare expansion

Tyrone couple cited as example for need to improve coverage

U.S. Sen. Bob Casey used the example of a Tyrone couple facing $31,000 in bills to push last week for an expansion in Medicare coverage.

Like a majority of Medicare recipients, Jim and Helen Sheehy in Tyrone are without dental, vision and hearing coverage under Medicare and under their Medigap coverage or Medicaid.

When Jim was diagnosed in 2015 with an aggressive form of skin cancer on his scalp, the side effects of radiation and chemotherapy treatment destroyed his teeth, necessitating their removal last year.

The couple’s Medigap insurer Highmark said Jim’s surgery at Geisinger Hospital in November 2018 wasn’t covered by Medicare.

“We were billed $32,000. They refused, and we worked through an appeal. At the end of June, Highmark paid $500 of the $32,000. We don’t know if Geisinger will bill us for the rest or we don’t know if we won the appeal. We may be able to move on from this. Jim still needs dentures that cost $3,500. The cancer treatment also affected Jim’s hearing. He just got a hearing aid for $1,600,” Helen said.

But Helen repeatedly said they have more to celebrate.

“His cancer is in remission,” she said.

“I’m not displeased with Highmark insurance. It is a gap in Medicare rather than a gap in Highmark,” she said.

Helen Sheehy had written to Casey in January about her husband’s dilemma in hopes he would consider expanding Medicare.

“My husband and I are fortunate that we can pay this bill if necessary — although it will substantially cut into our retirement savings. But there are many other seniors who aren’t as fortunate,” she wrote to Casey.

She was glad to see Casey come through.

Casey introduced his Medicare and Medicaid Dental, Vision and Hearing Benefit Act legislation in May. If enacted, it would guarantee that Medicare covers dental, vision and hearing services and would provide states with increased federal funding for Medicaid to provide that care.

The bill has been sent to the Senate Finance Committee, according to Congress.gov.

The proposal would ensure standard coverage for all Medicare beneficiaries without the need to purchase supplemental plans or private insurance.

Casey’s bill has one cosponsor, a senator from Maryland.

Helen Sheehy said she would like to see the state’s other senator, Republican Pat Toomey, cosponsor Casey’s bill. In addition there are companion bills in the House of Representatives, which Helen Sheehy hopes Rep. John Joyce, R-13th District, will cosponsor.

“Amid the recent unprecedented attacks on Medicare, I am committed to protecting seniors’ access to quality care through this program, which they have paid into throughout their lives,” a statement from Joyce read.

“It is important for these Americans to have both medical coverage and prescription coverage so that they can access their prescription drugs at affordable prices.”

Casey spokeswoman Aisha Johnson said Casey’s legislation got a boost from the House’s aim to lessen the cost of prescription drugs. She said Casey has not received a cost estimate of the legislation but “if Congress is able to reduce the price of prescription drugs, the House has floated the idea of using the savings to expand Medicare to cover these essential benefits (hearing, dental and vision care),” she said.

Medicare was designed over a half-century ago, along the lines of health insurance plans of the time.

The program consists of a hospital insurance program (Part A) in addition to a benefit for physician services (Part B), with payments for specific services included by law.

A majority of seniors lack dental coverage. According to Health Affairs, only 21 percent of Medicare beneficiaries purchase standalone dental insurance.

Coverage for the 14 percent of beneficiaries also eligible for state-run Medicaid is threadbare to non-existent in most states, according to Health Affairs.