The Hidden Truth About Medicare and Hearing Aids
Are you struggling with hearing loss and wondering if your Medicare plan will help cover the cost of hearing aids?
You’re not alone. With hearing aids costing anywhere from $1,000 to $6,000 per pair, finding coverage options is a major concern for many seniors.
You’re not alone. With hearing aids costing anywhere from $1,000 to $6,000 per pair, finding coverage options is a major concern for many seniors.
While Original Medicare (Parts A and B) does not cover hearing aids or routine hearing exams, there’s good news: many Medicare Advantage (Part C) plans offer hearing benefits that can significantly reduce your out-of-pocket costs. Let’s explore what you need to know about Medicare Advantage hearing aid coverage.
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Key Takeaways That Might Surprise You:
- The coverage gap is real – Medicare pays nothing while some Advantage plans offer thousands.
- Not all hearing aids are created equal – Technology tiers affect both benefits and clarity.
- Provider networks can be surprisingly restrictive – Your audiologist might not be covered.
- Timing matters more than you think – Wrong plan could mean years waiting for replacements.
- The hearing aid landscape is changing rapidly – New legislation and OTC option opportunities.
Understanding the Hearing Coverage Gap in Original Medicare
Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% of the cost for hearing aids and exams. This means if you have Original Medicare (Parts A and B), you’re responsible for the full cost of hearing aids and related services.
The only hearing-related services covered under Original Medicare are diagnostic hearing and balance exams, and only when they’re medically necessary and ordered by your doctor to determine if you need medical treatment.
Even then, you pay 20% of the Medicare-approved amount after you meet the Part B deductible and a hospital copayment if the exam is done in an outpatient setting.
Even then, you pay 20% of the Medicare-approved amount after you meet the Part B deductible and a hospital copayment if the exam is done in an outpatient setting.
How Medicare Advantage Plans Fill the Hearing Aid Coverage Gap
Medicare Advantage plans (Part C) are offered by private insurance companies approved by Medicare. Some Medicare Advantage Plans offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental. Medicare These plans must provide at least the same coverage as Original Medicare Parts A and B, but many go beyond that by including additional benefits.
According to the Kaiser Family Foundation data cited in several sources, most Medicare Advantage plans cover hearing aids and exams, though that coverage is limited and varies significantly by plan.
According to the Kaiser Family Foundation data cited in several sources, most Medicare Advantage plans cover hearing aids and exams, though that coverage is limited and varies significantly by plan.
What Hearing Benefits Do Medicare Advantage Plans Typically Cover?
The specific hearing benefits offered vary by plan, but they may include:
- Routine hearing exams: Many plans cover annual hearing checkups with low or zero copayments.
- Hearing aid fittings and evaluations: Coverage for professional services to ensure your hearing aids work properly for your specific hearing needs.
- Hearing aids: Partial or full coverage for the devices themselves, often with limitations on:
- Dollar amount (annual allowance)
- Frequency (how often you can get new hearing aids)
- Types or technology levels covered
- Brand restrictions
Follow-up care: Some plans cover adjustments and maintenance services.
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Coverage Limits and Restrictions
Before choosing a Medicare Advantage plan for hearing aid coverage, it’s important to understand the common limitations:
Dollar Amount Limitations
Most Medicare Advantage plans regulate the dollar amount or frequency of hearing aid purchases. In 2021, the average annual limit was $960, ranging from $66 to $4,000. This means plans may provide an allowance up to a certain dollar amount, after which you pay the remaining costs out-of-pocket.
Some plans from major insurers offer more generous coverage. For example, Aetna’s Medicare Advantage plan offers hearing aid coverage of up to $2,000 per ear.
Some plans from major insurers offer more generous coverage. For example, Aetna’s Medicare Advantage plan offers hearing aid coverage of up to $2,000 per ear.
Frequency Limitations
Typically, Medicare Advantage plans limit enrollees to one set of hearing aids a year, but more than a quarter of plans restrict hearing aid coverage to one pair every two years.
Some plans only cover new hearing aids every three years, so consider how often you might need replacements when choosing a plan.
Some plans only cover new hearing aids every three years, so consider how often you might need replacements when choosing a plan.
Technology Level and Copayment Structure
Many plans use a tiered system where your copayment depends on the technology level you choose:
Expect different copayments based on the level of digital technology — typically basic, standard, advanced and premium levels. Copays may start around $699 for an advanced-level hearing aid and $999 for a premium-level hearing aid.
For instance, The Humana Gold Plus HMO Medicare Advantage plan has a different breakdown of benefits. Annual hearing exams have a $0 copay. An “advanced” level hearing aid has a $699 copay per ear, per year while a “premium” level hearing aid has a $999 copay per hearing aid, per year.
Expect different copayments based on the level of digital technology — typically basic, standard, advanced and premium levels. Copays may start around $699 for an advanced-level hearing aid and $999 for a premium-level hearing aid.
For instance, The Humana Gold Plus HMO Medicare Advantage plan has a different breakdown of benefits. Annual hearing exams have a $0 copay. An “advanced” level hearing aid has a $699 copay per ear, per year while a “premium” level hearing aid has a $999 copay per hearing aid, per year.
Brand and Provider Restrictions
Many Medicare Advantage plans work with specific hearing aid vendors or networks. For example:
- Aetna offers Medicare Advantage plans with a hearing benefit. They teamed up with NationsHearing to provide hearing exams and hearing aid benefits.
- UnitedHealthcare offers access to one of the largest national networks of hearing professionals with more than 6,500 locations and a broad selection of over-the-counter (OTC) and brand-name prescription hearing aids.
- Humana partners with TruHearing and offers excellent low-cost, high-end Signia hearing aids and nothing else.
It’s crucial to verify that your preferred hearing care providers are in-network for any plan you consider.
How to Find Medicare Advantage Plans with Hearing Aid Coverage
To find Medicare Advantage plans in your area that cover hearing aids:
- Use the Medicare Plan Finder: Type your zip code into the Medicare Plan Finder and click Medicare Advantage Plan under Plan Type for plans in your area. A green check mark notes plans that include hearing benefits. Then click Plan Details and scroll down to Extra Benefits.
- Contact insurance companies directly: Call different insurance providers to ask about their Medicare Advantage plans with hearing benefits.
- Work with a Medicare insurance broker or advisor: These professionals can help you compare different plans based on your specific needs.
- Check with your audiologist or hearing care provider: If a senior is already working with an audiologist or other hearing care provider, it’s a good idea to ask the provider which Medicare Advantage plans are accepted at that clinic.
When Can You Enroll in a Medicare Advantage Plan with Hearing Benefits?
If you’re not currently enrolled in a Medicare Advantage plan with hearing benefits, you’ll need to wait for an enrollment period to make changes:
- Initial Enrollment Period: When you first become eligible for Medicare
- Annual Enrollment Period: October 15 to December 7 each year
- Medicare Advantage Open Enrollment Period: January 1 to March 31 each year (only if you’re already enrolled in a Medicare Advantage plan)
- Special Enrollment Periods: Available in certain situations like moving to a new area
What to Consider When Choosing a Plan for Hearing Aid Coverage
When evaluating Medicare Advantage plans for hearing aid coverage, consider these factors:
- Your specific hearing needs: If you already know what type of hearing aids you need, make sure they’re covered by the plan.
- Provider network: Check whether your preferred audiologist or hearing aid specialist is in-network.
- Coverage limits: Look at the annual allowance, how often you can get new hearing aids, and any brand restrictions.
- Copayments and cost-sharing: Understand what you’ll pay out-of-pocket for different levels of hearing aid technology.
- Overall plan benefits and costs: Remember that hearing benefits are just one aspect of Medicare Advantage plans. Consider premiums, deductibles, other benefits, and provider networks for all your healthcare needs.
The Growing Importance of Over-the-Counter Hearing Aids
A recent development in hearing healthcare is the availability of over-the-counter (OTC) hearing aids, which became available in October 2022 following FDA regulations.
These devices are designed for adults with mild to moderate hearing loss and are generally more affordable than prescription hearing aids.
These devices are designed for adults with mild to moderate hearing loss and are generally more affordable than prescription hearing aids.
Some Medicare Advantage plans may include OTC hearing aids as part of their coverage options. Advantage plan members often are able to use a Medicare Advantage flex card to buy OTC hearing aids at approved locations and through some mail-order pharmacy programs.
Companies like MDHearing, Eargo, Lexie Hearing, and Audicus offer OTC hearing aids, and some are working to increase coverage through Medicare Advantage plans.
Companies like MDHearing, Eargo, Lexie Hearing, and Audicus offer OTC hearing aids, and some are working to increase coverage through Medicare Advantage plans.
Potential Future Changes to Medicare Hearing Aid Coverage
There have been legislative efforts to expand hearing coverage under Original Medicare. In partnership with Rep. Brian Fitzpatrick, R-Penn., Rep. Debbie Dingell, D-Mich. reintroduced the Medicare Hearing Aid Coverage Act in January 2023. If it passes, the bill would remove Social Security restrictions that currently prohibit Medicare from paying for hearing aids.
While the outcome of these efforts remains to be seen, they indicate growing recognition of the importance of hearing health for seniors.
While the outcome of these efforts remains to be seen, they indicate growing recognition of the importance of hearing health for seniors.
Making the Most of Your Medicare Advantage Hearing Benefits
If you’re among the millions of seniors experiencing hearing loss, a Medicare Advantage plan with hearing benefits could save you thousands of dollars on hearing aids and related services.
The key is understanding exactly what’s covered under different plans and choosing one that best meets your hearing needs and budget.
The key is understanding exactly what’s covered under different plans and choosing one that best meets your hearing needs and budget.
Keep in mind that hearing aid technology continues to evolve, and coverage options may change from year to year. During each Medicare Annual Enrollment Period, take time to review your coverage and explore whether a different plan might better address your hearing healthcare needs.
Ready to explore your Medicare Advantage options? Contact Senior Benefit Services today for a free consultation. Our Medicare specialists can help you compare plans and find coverage that meets your hearing needs and budget. Call 1-800-924-4727 or visit our website at seniorbenefitclient.com to get started
Ready to explore your Medicare Advantage options? Contact Senior Benefit Services today for a free consultation. Our Medicare specialists can help you compare plans and find coverage that meets your hearing needs and budget. Call 1-800-924-4727 or visit our website at seniorbenefitclient.com to get started
Frequently Asked Questions About Medicare Advantage Hearing Aid Coverage
Do all Medicare Advantage plans cover hearing aids?
How much do hearing aids typically cost with Medicare Advantage?
Can I use any hearing aid provider with my Medicare Advantage plan?
How often can I get new hearing aids with Medicare Advantage?
What if I can’t afford hearing aids even with Medicare Advantage coverage?
Can I switch to a Medicare Advantage plan with better hearing benefits if I already have Original Medicare?
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