One of the first questions many patients ask is “Will my insurance company pay for hearing aids?”
This questions is very understandable because hearing aids are expensive. Even partial insurance coverage can help immensely with the cost. Unfortunately, there is not one easy answer to this question. We have seen insurance coverage vary from zero coverage to complete coverage, with no maximum. Below, we will go into detail about some different insurance options and their possible hearing aid coverage.
Traditional Medicare (Part B)
Traditional Medicare Part B is the red, white, and blue insurance card that many people are familiar with. Medicare Part B currently does not offer any coverage for hearing aids, hearing aid repairs or adjustments, or hearing aid supplies.
Traditional Medicare may cover an annual hearing test, but only if your primary care physician refers you for testing. If you choose to come in for a hearing test without a referral, you will be responsible for the cost of the hearing evaluation.
It’s unfortunate that Medicare Part B does not offer coverage for any hearing related services. People over age 65 are the most likely to be suffering from hearing loss.
Medicare Advantage Plans (Part C)
Some people over 65 choose a Medicare Advantage plan instead of traditional Medicare Part B. Private insurance companies, such as Aetna or United HealthCare, offer Medicare Advantage plans that provide Part A and B benefits. The majority of Medicare Part C plans will cover an annual hearing test without a referral from your primary doctor. Depending on your plan, there may be a required co-pay or co-insurance for this exam.
Some Medicare Advantage plans do offer coverage for hearing aids and related services. Most commonly, insurance plans will cover $1,000-$2,500 toward hearing aids every three years. Keep in mind, some Medicare Advantage plans do not offer any hearing aid benefits at all.
Sometimes patients will owe a certain percentage of the hearing aid cost as a co-pay or as co-insurance. Sometimes patients have to meet their deductible before the hearing aid benefit will kick in. There are a multitude of factors that will effect your out-of-pocket cost, even if you have a hearing aid benefit.
Some Medicare Advantage Plans offer their hearing aid benefit exclusively through a third party company. What this means, is that in order to take advantage of the $1,000 your insurance plan will pay towards hearing aids, you are required to go through a specific company. There are pro’s and con’s to utilizing third party companies for hearing aids, which we will detail below.
If you’re interested in switching over to a Medicare Part C plan, you can do this during the Medicare open enrollment period. Open enrollment typically runs from October to December each year.
Private Insurance
People who have insurance through their employers or through the Healthcare Marketplace have private insurance. A multitude of companies, such as Wellmark BlueCross BlueShield, Cigna, Medica, Aetna, and United Healthcare offer private insurance plans. Each of these companies offers numerous plans to choose from.
Private health insurance coverage will be similar to Medicare Advantage coverage for hearing aids. Some plans will have no coverage, while others will have extensive coverage. There may be co-pays, co-insurance, and deductibles that apply to the hearing aid benefit. They may also require the use of a third-party company to use your hearing aid benefit.
There are so many plans available, the only way to find out for sure, is to contact the insurance company and ask. Our office is more than happy to assist you in determining your hearing aid coverage.
Third-Party Companies
Some insurance plans will contract with third-party companies to administer their hearing aid benefits. These third-party companies will set the prices for hearing aids, and then partner with local audiologists to provide hearing services to their patients.
If your insurance plan requires the use of a third-party, you will need to find an audiologist that is contracted with that company. The most common third-parties that we work with are TruHearing, Hearing Care Solutions, and United Healthcare Hearing. We have contracts with others, but these seem to be the most common in our area.
Advantages of third-parties
Going through third-party companies can have some advantages. These companies will have contracted, set prices for hearing aids, which may be lower than purchasing elsewhere. You will know the complete out-of-pocket cost upfront, and there will be no surprise bill after the insurance processes the claim. There may be some hearing aids available at no charge to you. Lastly, you will be able to take advantage of the money your insurance company will pay towards hearing aids, if they require the use of a third-party.
Disadvantages of third-parties
Using a third-party company can limit your choice of audiologist. If your preferred audiologist is not contracted with the required third-party, you will have to find a new hearing healthcare provider, or pay out-of-pocket.
You may have a limited selection of hearing aids to choose from. Some third parties only offer products from one or two different hearing aid manufacturers. They may not offer all models or technology levels for a particular manufacturer.
You also lose the power to compare prices. If the contracted price through the third-party is higher than the price from your local audiologist, you won’t see the full benefit of your hearing aid coverage. In rare cases, we have seen patients have higher out-of-pocket cost for hearing aids, after their hearing aid benefit has been applied, than they would have paid to our clinic directly. In these cases, we are contractually bound to charge the third-party price to the patient, even if it is higher than our regular clinic pricing would have been. Fortunately, this is a rare situation. However, for people who don’t have a hearing aid benefit, it means you can get insurance-type pricing by going directly through Merit Hearing!
Lastly, going through a third party company can be slow. It can take 6 weeks or more for you to actually receive your hearing aids after the hearing exam. On the other hand, if you purchase through your audiologist directly, the turnaround time is typically 1-2 weeks after the hearing exam.
Medicaid
Some Iowa Medicaid plans do cover hearing aids. You must find an audiologist that is contracted with Iowa Medicaid or the Managed Care Plan you use.
The extent of hearing aid coverage will vary based on the patient’s age and other lifestyle factors. Many hearing aids will require a prior authorization process for approval. Medicaid plans often also have some coverage for hearing aid repairs and supplies, such as batteries and filters.
For more specific information, we recommend contacting the insurance company directly. We are happy to assist you with determining coverage for hearing aids and hearing services.
In Summary
Hearing aid benefits vary widely across insurance plans. The best way to determine if your insurance company will contribute towards the cost of hearing aids is to call them and ask. If possible, we recommend getting the coverage details in writing, just to be safe.
Over the years, we have seen more and more patients with some hearing aid benefits through their insurance. We are hopeful that this trend continues and more patients receive insurance coverage for their hearing health. We believe all patients with hearing loss should have the ability to obtain hearing aids at a reasonable cost.