As part of the budget reconciliation discussions, Congress has considered expanding traditional Medicare to cover preventive dental, vision, and hearing services. Current proposals under the Build Back Better legislation would expand Medicare to cover hearing services for enrollees. In this brief, we describe current use of and spending on routine vision and hearing services among all Medicare beneficiaries and select subgroups. We show that enrollees spent about $8.4 billion on routine vision services and $5.7 billion on routine hearing services in 2020. These spending totals are small relative to the $1.1 trillion in total Medicare spending in 2020 (including Medicare, beneficiary, and supplemental insurance spending). About 31 percent of Medicare enrollees used routine vision services in 2020, with average total vision expenditures of $411. Only 6.5 percent of Medicare enrollees used a routine hearing service, but average spending was high ($1,302) among those who did. Fee-for-service Medicare enrollees had greater expenditures on vision services than did Medicare Advantage enrollees (an average of $437 versus $361), whereas spending on routine hearing services was similar for fee-for-service and Medicare Advantage enrollees (an average of $1,379 versus $1,127). Use of and expenditures on vision and hearing services both increased markedly with income. On average, Medicare enrollees dually enrolled in Medicaid spent far less than enrollees without Medicaid on both vision and hearing services. Our findings suggest that if Medicare were expanded to cover vision and hearing services, it would primarily benefit lower-income enrollee groups who may have considerable unmet needs for these services.