Hearing Aids & Medicare… what’s the truth?

By: admin | December 29, 2018

Hearing aids can be expensive. The National Institutes of Health (NIH) found that the average price of a digital hearing aid that requires fitting procedures was about $1,500 and that some hearing aids cost up to $5,000 (as of 2013). It’s no wonder you may be asking, “Does Medicare cover hearing aids?”

Unfortunately, if you’re covered by Original Medicare (Part A and Part B), the answer is no. But you may have other options. Here’s what you should know about Medicare and hearing aid coverage.

What hearing aid services are covered by Medicare?
If your doctor believes you have a medical condition requiring treatment that can be diagnosed with a balance test or diagnostic hearing exam, Part B may cover 80% of allowable charges for these tests (after any applicable deductible). If you get these tests as an outpatient at the hospital, the hospital copayment may also apply.

Under Original Medicare, you usually pay 100% of the costs associated with routine hearing exams and hearing aids.

Does Medicare Advantage cover hearing aids?
Medicare Advantage plans must cover everything that Original Medicare (Part A and Part B) covers (besides hospice care, which Part A still covers), which means medically necessary diagnostic hearing and balance tests may be covered under your Medicare Advantage plan.

However, some Medicare Advantage plans may choose to offer additional benefits, such as coverage for prescription drugs and routine hearing, vision, and/or dental care, so in some cases hearing aids may be covered. Some plans even include benefits for wellness programs and discounts on over-the-counter medications.

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

Health Maintenance Organizations (HMOs). HMOs usually include coverage for prescription drugs as well as other optional benefits, such as routine hearing services. HMOs may require you to get your health care from providers in the plan’s network, except for medically necessary emergency care. You may even qualify for a Special Needs Plan (SNP), which is a low-cost HMO with enrollment limited to people with certain medical conditions, or who 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?
Here are some things you should 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 Medicare Advantage plans, you may need 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 pay a set amount you can apply 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 may be available in all areas. Your premium may vary depending on where you live and the type of plan you choose.

If you would like more information about Medicare coverage for hearing aids, I’m happy to help. To request information via email, or to schedule a telephone call, click one of the links below. You can view a list of plans in your area you may qualify for by clicking the “Compare Plans” button.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Courtesy of Jory Cross/medicare.com

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