Hearing Aid Insurance Benefits: What to Verify
Hearing-aid benefits vary widely. Two people insured by the same company may have different coverage because benefits depend on the specific plan, employer group, service, device, provider network, and benefit year.
What a hearing-aid benefit may include
A plan may provide a fixed allowance, contracted hearing-aid prices, device copays, selected technology, or access through a hearing-benefit administrator. Other plans do not include a hearing-aid benefit. Deductibles, coinsurance, authorization rules, replacement-frequency limits, and network requirements may also affect the final cost.
Third-party hearing-benefit programs
Some insurance plans require patients to use a third-party program to receive the hearing-aid benefit. All Merit Hearing locations and providers work with TruHearing, NationsHearing, UHC Hearing—also known as EPIC Hearing or Ear Professionals Network—Your Hearing Network, Amplifon, and Start Hearing. Iowa locations also work with VA Care in the Community.
Most third-party plans include three follow-up visits during the first year, but this is not universal. The program controls device selection, pricing, service allowances, return processing, and other terms. Those terms may differ from a hearing aid purchased directly from Merit Hearing.
Private insurance participation varies
Participation with private insurance plans varies by Merit Hearing location and provider. Current participation is listed on each location page, but network information and benefits can change. Contact the applicable office before care so the team can check current participation and available benefit information.
Information needed for verification
When scheduling, provide the insurance name, member ID number, patient’s full name, and date of birth. Merit Hearing strives to check hearing-aid benefits before the appointment so the information can be discussed with the hearing-test results and considered during recommendations.
If a copy of the insurance card is needed, bringing it to the office is preferred. The front and back may also be faxed to the applicable office. We discourage sending insurance-card images through standard email because it is not secure for protected health information.
Insurance verification is not a guarantee
A benefit verification reflects the information available from the plan before service. The insurer or benefit administrator makes the final determination when a claim or benefit is processed. Ask for a written estimate that identifies the devices, included services, applicable benefit, and expected out-of-pocket cost.
Medicare coverage is different
Original Medicare does not cover hearing aids or examinations performed solely to fit hearing aids. Some Medicare Advantage plans offer additional hearing benefits with plan-specific networks and rules. Read Does Medicare Cover Hearing Aids? for a detailed explanation.
Compare the complete package
Before choosing between an insurance program and a direct purchase, compare the specific device, warranty, trial period, follow-up care, future service fees, and total expected cost. Merit Hearing’s Hearing Aid Cost Guide explains what is included with direct purchases and how to compare written estimates.
Next step
Contact your preferred Merit Hearing location with your insurance information before the appointment. The office can explain what was verified and help you compare the available paths.