By NextBestFitDurable medical equipment
Basic eyeglasses and hearing aids become covered. Designer frames, premium hearing aids, and convenience items (40% of today's out-of-pocket spending) remain out of pocket. Utilization rises 25%, mostly for hearing aids: only about 30% of adults over 70 who would benefit from one have one.
Result
$93.3B
$86.4B → $93.3B
Per resident, per year
$273
÷ 341.1M people
Per household
$706
÷ 132.2M households
Range
$89.4B–$101.0B
Lean and costly scenarios.
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | 2024 spending on this service (CMS NHE Table 4) Sources: CMS Office of the Actuary (2025) | $86.4B | |
| 2 | Private health insurance paid $18.9B at 1.20× the reference price → volume Sources: CMS Office of the Actuary (2025) | $18.9B ÷ 1.20× | $15.8B |
| 3 | Medicare paid $18.5B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025) | $18.5B ÷ 1.00× | $18.5B |
| 4 | Medicaid paid $11.5B at 0.80× the reference price → volume Sources: CMS Office of the Actuary (2025) | $11.5B ÷ 0.80× | $14.4B |
| 5 | Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025) | $35.8B | |
| 6 | Stays out of pocket (items UHP excludes: 40%) | $35.8B × 40% | $14.3B |
| 7 | Covered out-of-pocket converted to reference-price volume | ($35.8B − $14.3B) ÷ 1.30× | $16.5B |
| 8 | Care UHP takes over, valued at 2024 prices | $70.4B | |
| 9 | Same care valued at the reference price (Medicare competitive-bidding prices) | $65.1B | |
| 10 | Re-priced at UHP rate 0.95× | $65.1B × 0.95× | $61.9B |
| 11 | Price effect (same care, new prices) | $61.9B − $70.4B | −$8.5B |
| 12 | Utilization multiplier 1.25× | $61.9B × 1.25× | $77.4B |
| 13 | Utilization effect (more care) | $77.4B − $61.9B | $15.5B |
| 14 | UHP spending on this service | $77.4B | |
| 15 | Plus spending that stays out of pocket | $14.3B | |
| 16 | Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged) | $0.3B | |
| 17 | Plus Other third-party payers & programs (continues unchanged) | $1.3B | |
| 18 | Total national spending on this service under the plan | $77.4B + $14.3B + $1.6B | $93.3B |
| 19 | Change from 2024 | $93.3B − $86.4B | $6.9B |
Trade-off: Providers of this service receive $8.5B less for the same care; patients receive $15.5B more care.