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Does Medicare Cover Audiologist?

First let’s dive into exactly what an audiologist is and does.

Audiologists are health care professionals who specialize in disorders dealing with hearing, balance, and other neural systems.   Once a disorder is diagnosed these healthcare providers fit and dispense hearing aids and other types of listening devices if appropriate.  Keep in mind that an audiologist does not perform surgery.  If you suffer from a hearing issue that requires surgery, then you will need to see an ENT doctor.

Types of Hearing Loss

While hearing loss can come in many forms that can range from minimal to total loss of hearing.  There are two broad categories of hearing loss:

• Sensorineural hearing loss – which is when there is usually permanent damage to the inner ear or auditory nerve.
• Conductive hearing loss – occurs when sound waves cannot reach the inner ear.  Typically medical treatment or surgery can correct the hearing loss.

As we age, the odds of hearing loss increase.  It is estimated that 1 in 3 people between the ages of 65 and 74 suffers from a certain degree of hearing loss.  For those older than 75 nearly half has difficulty hearing clearly.  This type of hearing loss is often times called Age-Related Hearing Loss but is medically diagnosed as Presbycusis.  This type of hearing loss comes on gradually as we get older and it seems to run in families.  Additionally this type of hearing loss usually (but not always) occurs in both ears.  Once the hearing loss has progressed substantially, many older adults will look to hearing aids as a solution.

What Does Medicare Cover?

So…does Medicare cover audiologist? Medicare will cover diagnostic exams with an audiologist when a healthcare professional such as a physician, clinical nurse specialist, nurse practitioner, physician’s assistant or other approved provider refers you to an Audiologist to determine appropriate medical care for your hearing issue.  If this criteria is met then Medicare Part B will generally cover 80% of the approved charges (after the annual Part B deductible has been met) leaving you or your Medicare Supplement to pay the other 20%.

So does this mean that a healthcare professional can refer you to an audiologist for a routine hearing test and Medicare will cover it?  No.  Medicare does not cover routine hearing tests, hearing aids, or the exams for fitting of hearing aids.

 

Does a Medicare Advantage plan cover hearing aids?

If you are covered by a Medicare Advantage plan you could possibly have some coverage for hearing aids.  While not all plans provide this additional coverage, some do.  Many times there are strict limitations on the actual benefits and coverage limits for hearing aids.  Some plans may cap out a certain dollar amount they will pay, while other plans may pay a higher amount towards hearing aids, but will limit the purchase to once every few years.

Keep in mind that most Medicare Advantage plans use a network, such as a PPO or HMO.  This means that if your plan does actually provide benefits toward hearing aids, you will need to see an audiologist that is part of that plan’s network.

 

How Else Can You Get Benefits For Hearing Aids?

If you are on traditional Medicare Parts A & B (whether you have a Medicare Supplement or not) you can always purchase stand-alone coverage for hearing benefits.  While these plans are not usually sold with just hearing benefits, you actually get 3 areas of coverage with them.  This includes dental, vision, and hearing.  To find out more about these plans click here.

Takeaway

If you are having hearing issues, your first step should be to schedule a visit with your primary care physician to discuss your concerns.  If you have questions about obtaining coverage for possible future hearing issues, then feel free to call us at (800)924-4727 or click on the Get A Quote Now button above.

So How Much Will Medicare Cost in 2023?

Medicare cost for 2023 showed an increase to  Part A deductible, but a small decrease to the Part B annual deductible over 2022.

In addition, the daily co-payments under Part A of Medicare showed increases in each phase.  The Medicare Part B coinsurance still remains at 20% as it always has.

 

If you worked 40 quarters during your lifetime, you will not be charged the Part A premium listed above.  During your working years, the Part A premium was paid thru your Medicare taxes from each payroll cycle.

The deductible for Part A increased from $1556 in 2022 to $1600 for 2023.  For days 61-90 of inpatient hospital care the daily co-payment rose from $389 per day in 2022 to $400 per day for 2023.  This will be an increase of $11 per day.  The lifetime reserve days which are days 91-150 of inpatient hospital care rose from $778 per day in 2022 to $800 per day for 2023.  This will be an increase of $22 per day.

Finally under Part A of Medicare the daily co-payment for skilled nursing facility care will increase from $194.50 per day in 2022 to $200 per day in 2023.  This will be an increase of $5.50 per day.

To compare our current chart to 2022 numbers click here.  To see the Medicare Fact Sheet click here.

To read about the 3 Most Common Questions Asked About Medicare Part A click here.  To read about the 3 Most Common Questions Asked About Medicare Part B click here.

Wondering if you are paying too much for your current Medicare coverage?  Get a FREE, NO OBLIGATION quote by clicking below or call (800)924-4727 for immediate service.

Traveling Abroad With Medicare

Well its that time of year when folks are doing a bunch of traveling.  Keep in mind that traveling domestically is different than Medicare foreign travel.  The great news is that anyone on Original Medicare can travel anywhere in the United States and have access to medical care from almost any hospital or doctor.

So now you might be wondering “What’s the bad news?”  Keeping in mind that the Medicare program is unique to the United States, it is not designed to provide benefits outside of the U.S. or its territories.  Medicare usually does not cover health care expenses when traveling outside the U.S., but there are some exceptions such as:

• Part B of Medicare may pay for care received on board a ship as long as it is within territorial waters, but it won’t pay for those services when a ship is more than 6 hours away from the nearest U.S. port.
• Medicare may pay for certain expenses in a foreign country if you are in the U.S. when a medical emergency occurs and a foreign hospital is closer than the nearest U.S. hospital.

 

 

 

How To Prepare

The good news is that with a little bit of advance knowledge and preparation, you can travel pretty much worry free about unforeseen medical expenses.  Currently most folks on Medicare fall into 1 or 2 groups.  They either have Original Medicare with a Medicare Supplement or they have a Medicare Advantage plan.  Let’s go quickly review how each works for foreign travel.

Some Medicare Advantage Plans provide you with worldwide emergency coverage.  Not all Medicare Advantage plans provide additional foreign travel coverage so it is imperative that you review your coverage before traveling.  Some plans that do provide additional foreign travel emergency care may want you to notify them before leaving the country.  If your Medicare Advantage plan does not provide additional benefits for foreign travel, it must still provide the same benefits that original Medicare would cover (see exceptions above).  Once again this is for emergency care only and not for routine types of visits.  Keep in mind that many foreign hospitals do not bill the plan directly so you will likely have to pay for these costs upfront and then submit an itemized bill to your plan for reimbursement.  Be sure to keep all of your medical receipts if anything unexpected happens.

For those folks on original Medicare and have a Medicare Supplement, the coverage will work a bit differently.  Original Medicare will not pay outside the U.S. (unless it qualifies as a listed exception) so you will need to have any of the following Medicare Supplement plans to provide your coverage:

• Plan C
• Plan D
• Plan F
• Plan G
• Plan M
• Plan N

 

The Medicare foreign travel benefit found in these plans is very simple.  There is a separate $250 deductible and then the plan will pay 80% of the costs up to a lifetime maximum of $50,000.  Keep in mind that your coverage is in effect during the first 60 days you are out of the country.

 

Take Away

So as you can see, you actually do have coverage under certain Medicare Supplement and Medicare Advantage plans.  With coverage being more restrictive outside the U.S. it is always best to purchase an additional travel policy to help supplement your existing coverage.  A word of caution, not all travel plans provide emergency health benefits, so be sure to get one that specifically does.  Check the fine print for such things as will the plan pay actual charges or ‘usual and customary‘, and how pre-existing conditions are treated.  If the policy will not cover pre-existing conditions and you have a Medicare Supplement plan with foreign travel benefits, then you could use your travel plan for any emergency or sickness not related to a pre-existing condition (and vice-versa for anything related to a pre-existing condition).  These plans can usually be purchased thru a travel agent and can provide coverage past 60 days.  Medicare foreign travel planning will make your next international trip much more relaxing.

Today we are going to quickly discuss whether or not you have to enroll in a Medicare Part D Prescription Drug Plan.  While the answer to this question is easy to answer, there is a big reason why you might just not want to go along with it.

 

Do I have to enroll in a Medicare Part D Prescription Drug Plan?

No!  There is no law that says you MUST enroll in a Part D Plan, but the penalties for not doing so will hit you squarely in the wallet.  First you must understand that for Medicare Part D to actually work, it must have a balance of folks who take little to no prescription drugs to offset all the folks taking large amounts of prescriptions.  If you could simply start Medicare Part D at any time, most people would simply wait until they were on a number of expensive prescriptions to go and sign up for the benefit.

What are the penalties for waiting?

The Medicare Part D late enrollment penalty is 1% ‘simple interest’ per month that you do not have a Part D plan or other credible coverage.  Credible coverage can be prescription drug benefits provided thru a group health plan that you are covered under at your place of employment or thru your spouse.  While 1% does not sound like much, keep in mind that it is per month you were without coverage when you were eligible.  In the sample below you will see how quickly the penalty adds up when a person does not sign up for a Part D plan when first eligible.  In this example the individual waited 34 months before finally deciding that they needed to get coverage.  We are also going to say that the Part D plan they want to now enroll in has a monthly premium of $18.00 per month.  It would be great if the penalty was based off of whatever plan premium you selected, but it doesn’t work that way.  The penalty is based off of what CMS announces as the national average (and that typically goes up each year).  For year 2022 the national average is $33.00 per month.

 

Based on the example above, this individual who could of been paying only $18.00 per month for their Part D Prescription Drug Plan must now pay $29.20 per month in 2022.  Each year for the rest of the time this individual is enrolled in Medicare Part D the penalty amount will have to be re-worked.  So this means that if in 2023 the national average is $35 per month, and the consumer stays in the exact same priced plan of $18 per month, then they will have to now pay $29.90 per month.  If they needed to move to another plan due to prescription no longer being covered in their old plan, the $11.90 penalty amount would be applied to the new plan premium.

 

Why should I enroll in a Medicare Part D Prescription Plan when I am not taking any prescriptions?

The short answer is that you will not face the late enrollment penalty.  Keep in mind that the late enrollment penalty percentage will follow you each year no matter which plan you are enrolled in.  The next reason why you should at least be enrolled in the cheapest premium plan is that you never know when your doctor may have to prescribe a prescription and you want to have coverage to help pay for it.  In reality, we never know what kind of prescription we might need or how expensive it will be.

 

Have additional questions?

Contact Senior Benefit Services to get guidance on what to do if you did not sign up for a Medicare Part D prescription drug plan when first eligible.  We are here to help (800)924-4727