Knowing the ins and outs of your health care plan is the first step to figuring out the right hearing loss treatment option for you. Coverage varies widely from plan to plan and from state to state. Unfortunately, hearing aid coverage is lacking, and improvement may require new federal laws. Until then, here are some general guidelines about hearing health coverage to help you plan for your new hearing aids.
First Things First
To get accurate treatment you need the right diagnosis. Most insurance plans will cover a hearing test if ordered by a physician. If you have private insurance, call your insurance plan or check with your doctor to figure out which tests are covered before you seek treatment.
“Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to see if you need medical treatment. Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids.”
If hearing tests are deemed medically necessary, Medicare Part B may pay 80% of the allowed amount, after the patient meets their yearly deductible.
Original Medicare (Part A and Part B) usually won’t pay for hearing aids.
Medicare Advantage (Part C) may provide coverage for routine hearing tests and hearing aids. Medicare Advantage plans, or “Part C” or “MA Plans,” are offered by private companies approved by Medicare. Medicare pays a predetermined amount each month to the companies offering Medicare Advantage Plans. These companies are obligated to follow the rules established by Medicare. Medicare Advantage Plan vary on out-of-pocket costs and have different rules for obtaining medical services.
Medicaid Hearing Coverage Basics
More than 50% of states provide some coverage for hearing aids, tests, exams, repairs, replacements, batteries and accessories.
Medicare will not cover the cost of hearing aids for adults. Medicaid will cover diagnostic exams ordered by a physician. Medicare may also cover bone-anchored hearing aids (BAHA). BAHAs are surgically implanted and classified as prosthetics.
Under the guidelines of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program, all states must provide coverage for hearing screening, diagnostics and treatment to all Medicaid beneficiaries under age 21. Treatment coverage includes hearing aids.
Since hearing aid coverage is nationally inconsistent, visit https://www.benefits.gov/ to determine coverage in your state. Your doctor or plan representative can help you figure out your coverage eligibility.
Other Options to Offset the Cost of Hearing Aids
Qualified veterans are eligible for hearing services and hearing aids through the Veterans Administration (VA). Contact your local VA for more information.
Most licensed hearing healthcare providers offer a wide range of financing options for their patients. Make sure you research the creditor and the terms before signing up.
Check with local civic organizations about hearing aid assistance.
Several hearing aid manufacturers sponsor programs to assist hearing aid users with limited financial resources.
If you have questions about your coverage or for help in determining which questions to ask your insurance provider, call our office.