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Audiologist Answers Questions About Medicare and Hearing Aids Coverage

Have you ever wondered if your Medicare coverage includes hearing benefits?

We can certainly understand why you might ask; hearing aids can be expensive, especially when they require fitting. The National Institutes of Health (NIH) found that the average combined price of a digital hearing aid and its fitting procedures was about $1,500, with some ranging up to $5,000.

While Original Medicare does not cover hearing aids or their batteries, a growing number of Medicare Advantage plans (Medicare Part C) are adding hearing benefits. These benefits can help make high-quality hearing aids and hearing services more affordable, saving you thousands of dollars in the process.

To help make sense of it all, we asked Steve DeMari, CaptionCall’s Director of Business Development and Education with more than 30 years of experience in the audiology and hearing aid industry, some of the most pressing questions about Medicare and hearing health benefits.

Does Original Medicare cover hearing aids?

According to the Center for Medicare Services (CMS), “Medicare doesn’t cover routine hearing exams, hearing aids, or exams for fitting hearing aids.” It does, however, cover certain diagnostic hearing tests. If you qualify for a diagnostic hearing test under Original Medicare, you will still be responsible for the Part B deductible plus 20% of the test.

Does Original Medicare pay for hearing care?

Unfortunately, if you are covered by Original Medicare (Part A and Part B), the answer is no; you must pay 100 percent of the costs for exams and hearing aids out of pocket.

There are, however, other options. Original Medicare will help pay for hearing and balance exams if they are deemed medically necessary by your health care provider. If you are recommended for a Medicare-approved hearing or balance exam, you will typically pay up to 20 percent of the Medicare-approved amount of the doctor's exam along with the Medicare Part B deductible. A Medicare Supplement Insurance plan can help cover your out-of-pocket Medicare costs if you get a permanent hearing device, such as a cochlear implant.

Are cochlear implants covered by Original Medicare?

The cost of cochlear implants and other permanent, auditory implants is partly covered by Medicare Part B. If your doctor decides that you need a cochlear implant, you will most likely be responsible for paying 20% of the Medicare-approved amount for the implant along with the Medicare Part B deductible.

What hearing aid services are covered by Original Medicare?

As mentioned, you usually pay 100% of the costs associated with routine hearing exams and hearing aids under Original Medicare, but if your doctor believes you have a medical condition that requires treatment and can be diagnosed with a balance test or diagnostic hearing exam, Part B may cover 80% of allowable charges for testing (after any applicable deductible). If you get these tests as an outpatient at the hospital, the hospital copayment may also apply.

Does Medigap cover hearing aids?

While it offers additional coverage beyond Original Medicare, Medigap usually does not cover hearing aids. If you have Medigap Plan C or F, it will cover 100% of your Medicare Part B deductible and will pay 100% of the hearing diagnostic test’s coinsurance. This means that you would not pay anything for the diagnostic test.

Some states, such as California and Nevada, may offer coverage or exceptions in their Medigap plans. Check your state-specific regulations to see if you qualify for Innovative Plan F. You may be entitled to $750 towards hearing aids each year.

Hearing Aid

Does Medicare Advantage cover hearing aids?

Medicare Advantage (MA) plans may cover some hearing aids and diagnostic testing costs, but most do not. MA plans are not standardized, so each one is different.

MA plans may choose to offer additional benefits, such as coverage for prescription drugs, wellness programs, and routine hearing, vision, and/or dental care. Some of these plans offer a $0 copay for routine hearing exams and low copays on name-brand hearing aids. Seniors who are experiencing hearing loss or expect to need hearing care in the future should consider investing in a Medicare Advantage plan unless they want to pay out of pocket for their hearing aids.

Depending on where you live, you may be eligible for one of these two types of Medicare Advantage plans that may include hearing aid coverage:

  • Health Maintenance Organizations (HMOs): HMOs usually include coverage for prescription drugs as well as other optional benefits, such as routine hearing services. Unless you are in need of emergency medical assistance, you may be required to seek care from providers in the plan’s network. You may even qualify for a Special Needs Plan (SNP), which is a low-cost HMO with enrollment limited to people who have certain medical conditions, live in a nursing home, or are eligible for both Medicare and Medicaid.
  • Preferred Provider Organizations (PPOs): These plans let you choose from any provider who accepts your plan, but your out-of-pocket costs are much lower if you use in-network providers. Many PPOs include extra benefits for prescription drugs and routine hearing, vision, and dental care.

What else should I know about Medicare Advantage and hearing aid coverage?

When you enroll in a Medicare Advantage plan with hearing aid coverage, you may have to pay a monthly premium in addition to your regular Part B premium. (Paying your Part B premium is required with all Medicare Advantage plans.) With many MA plans, you may be required to use a doctor or audiologist in the plan’s network in order to access benefits for your routine hearing services and hearing aids. You may also have a copayment or coinsurance amount. Some plans pay a percentage of your hearing aid costs, while others offer a set amount that can be applied toward the purchase of a hearing aid.

There may be an annual limit on the amount of money your plan will pay each year toward your routine hearing care and hearing aids. It’s important to note that not all Medicare Advantage plans include these extra benefits for hearing aids and routine hearing care, and not all plans are available everywhere. Your premium may vary depending on where you live and the type of plan you choose.

Buyer Beware! According to one audiology professional, “there are options from $0-$5000, and consumers have the right to make those choices. Get the information first; if they pressure you—walk out. All hearing aids should have a trial period.”

It’s also important to note that many Medicare Advantage and supplemental plans do offer hearing device benefits in addition to other ancillary products. These plans will typically have higher dollar amounts than the built-in benefits of some Medicare Advantage plans. Although recently, dental, vision, and hearing have been a primary focus in increased benefits with many of the major Medicare Advantage options. The coverage under these plans is usually limited to a select network of audiologists and hearing care providers. If you already have an audiologist, there is no guarantee that they are in the network, and they may not accept your insurance plan. For many standalone hearing plans, you can see any HCP you want, though, usually there is a network of providers you can see to receive discounted services.

Regardless of the Medicare advantage plan you have, any audiologist or HCP you see will be able to offer you no-cost Internet Protocol Captioned Telephone Service (IP-CTS), such as CaptionCall, if your hearing necessitates the use of captioned telephone service. This service is federally funded and is available to all who are eligible. Your health plan typically doesn’t mention these no-cost services, but you can absolutely receive them through your audiologist or HCP. You can go here to learn more about this service.

Is there other important information about Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” that are an “all-in-one” alternatives to Original Medicare?

They are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (hospital insurance), Medicare Part B (medical insurance), and usually, Medicare prescription drug coverage (Part D).

Medicare pays a fixed amount for your care each month to companies offering Medicare Advantage plans, and these companies must follow rules set by Medicare. Each MA plan can charge different out-of-pocket costs.

Please be aware that even if you subscribe to a plan that claims to charge zero premiums, YOU still must pay your monthly Medicare premiums.

What does the above question mean?

That means the insurance company from which you purchase your plan is paid a monthly amount by Medicare to accept you as a patient. Then, Instead of paying your premiums to Medicare, you pay them to the company. Depending on how your plan is structured, you may or may not have to pay additional premiums on top of your Medicare premiums (where the zero-premium claim comes in).

Medicare Advantage plans can also have different rules for how you access services, such as whether or not you need a referral to see a specialist. They may also require you to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care. Rules are subject to change each year.

Medicare Advantage plans cover all Medicare services. Some plans also offer extra coverage, like vision, hearing, and dental coverage, and this is where things can get complicated. Even though some Medicare Advantage plans claim to offer a hearing aid benefit, you should be fully educated about how it all works:

  • “After working with several of these plans, we have found that sometimes the hearing aid benefit covers only a low-end hearing aid that may either be less sophisticated than some of the older hearing aid technology our patients are already wearing or inappropriate for the type of hearing loss they have.”
  • “In other cases, the plans are so restrictive in terms of providers or treatment choices that the hearing aid coverage turns out to be of little benefit at all.”
  • “Before you sign up for an advantage plan, check the benefits very carefully, as they relate to all your health-related services.”

Will the professional I see for hearing aid services check my benefits?

For hearing aids, most audiology offices can check the benefits to see if the health plan has hearing aid coverage. In some cases, these plans cover mail-order devices, and in others, they have providers enrolled to provide coverage for members who want to utilize their benefit.

Audiologist

How do I find a Medicare Advantage Plan that covers hearing aids?

Seniors who need coverage for hearing care, including testing and hearing aids, should begin by contacting their Medicare Advantage provider to determine whether it is covered under their existing plan. If it is not, their insurer can usually suggest a more suitable plan that offers the coverage they need; however, seniors who want to switch plans may need to wait until the general enrollment period to make the change. This occurs every year from October 15 to December 7.

If a senior is already working with an audiologist or other hearing care provider, it's a good idea to ask the provider which Medicare Advantage plans are accepted. Medicare Advantage plans generally only cover care at in-network providers, so selecting a plan that is already accepted can help eliminate the need to find a new health care provider.

Are there any exceptions to the above rules?

The exception is for people who receive care through the Department of Veterans Affairs, as the VA covers hearing aids and other hearing care for eligible seniors and may help with costs. Veterans should contact their local VA for audiological services. Also, if you need further support, you may contact a local civil service organization that can help you find hearing assistance, such as Sertoma.

How much do hearing aids cost?

Hearing aid prices can vary significantly. The most basic models cost around $1,500, and specialized hearing aids can run you between $5,000 and $7,000. In addition, seniors often must pay for hearing tests and other specialized care to determine whether they need hearing aids. Medicare Advantage plans that offer hearing coverage will cover some or all that cost. The actual amount covered depends on the specific plan and may vary based on factors, like the premium cost, deductible level, and the total amount you have already paid out-of-pocket for co-pays and other expenses during the calendar year.

How do third party and TPA plans work?

The majority of major insurers who offer Medicare Advantage plans have at least one plan that covers hearing aids. These insurers include UnitedHealthcare, Humana, Aetna, and Blue Cross Blue Shield. Some seniors may not be eligible for these plans, however, and the plans may have a higher premium than those that don't offer hearing aid coverage.

There are other contracted health plan hearing providers such as:

  • United Healthcare Hearing
  • Tru Hearing
  • American Hearing Benefits
  • Nations Hearing
  • Amplifon
  • Zip Hearing
  • Audionet America
  • Hearing USA
  • Hearing Life
  • Connect Hearing

How can I file a consumer complaint?

Increasingly, patients submit claims believing they have insurance benefits that cover the cost of hearing aids, only to have their claims denied. If you believe you have been wrongly denied, you can file a claim complaint. You can also file an insurance complaint against your health insurance provider regarding any health matter you believe was unjustly denied or confusing.

Further information:

  • https://www.medicare.gov/search/medicare?keys=hearing
  • For TTY users, the number to call for Medicare information is 1-877-486-2048.
  • Visit Medicare.gov to learn more about the features and benefits of Medicare. If you have further questions or concerns, contact the Medicare administration directly at 1-800-MEDICARE (1-800-633-4227).