Why Are Hearing Aids Not Covered By Medicare
Hearing aids are expensive and are not covered by Medicare. We look at what Medicare is and what hearing care coverage is provided.;
Hearing aids can be prohibitively expensive and you might find yourself asking why they are not covered by Medicare. To answer the question, we would need to first look at what Medicare is and then look at what hearing care coverage is provided.
Medicare Part B And Hearing Aids
Partie B in Medicare does not make hearing aids or hearing aid fitting tests. Medicare Part B usually covers medically needed services to treat an active medical condition.
While Medicare Part B does not cover hearing aids, it does cover hearing tests prescribed by a doctor to diagnose a hearing problem. The person on the program, however, remains responsible for paying 20 per cent of the bill.
They will also have to pay a portion of any remaining policy deductibles. Individuals who attend a hearing test in a hospitals emergency department will need to cover a co-payment directly to the health care provider.
Medicare Part B also provides hearing aids with bone anchoring . Medicare categorizes the BAHA as a prothetic system rather than a hearing aid.
A BAHA is a surgically implanted system that supports individuals with some forms of hearing loss. This operates differently than traditional hearing aids. A BAHA transmits sound waves by bone conduction, activating the cochlea and bypassing the outer and middle ears.
It is important to realize that a BAHA is not the same as a conventional hearing aid. It may however be an option for certain individuals with other types of hearing loss.
Why Hearing Benefits For Seniors Are So Important
Imagine being unable to effortlessly communicate with your friends and loved ones. For many adults over age 65, this is the reality. The National Institute on Deafness and Other Communication Disorders states that approximately a third of people ages 6574 have hearing loss. For those 75 and older, that goes up to half.
Hearing loss can have several side effects. You may have trouble understanding your doctors advice, responding to warnings, or hearing doorbells and alarms. In fact, studies have shown that seniors with hearing loss have a greater risk of developing dementia and declining cognitive abilities .
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How Much Do Hearing Aids Cost
Hearing aids can vary significantly in cost, but most basic models cost around $1,500. Specialized hearing aids can cost between $5,000 and $7,000. In addition, seniors often have to pay for hearing tests and other specialized care to determine whether they need hearing aids.
Medicare Advantage plans that offer hearing coverage will cover some or all of that cost. The actual amount covered depends on the specific plan and may vary based on factors, such as the premium amount, deductible level and how much the insured has already paid out-of-pocket for co-pays and other expenses during that calendar year.
Why Doesn’t Medicare Cover Hearing Care
As this clinical review explains, “The Medicare Act of 1965 statutorily excluded coverage of hearing aids under the premise that they were ‘routinely needed and low in cost,’ suggesting that consumers would be responsible for their purchase.” Also, at the time, many seniors didn’t live as long as they do today, and so fewer people had age-related hearing loss. There also was little understanding of how important it is to treat hearing loss to reduce depression and social isolation.
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How Are Hearing Aids And Hearing Care Covered Under Medicare Part B
Medicare Part B may cover care for a hearing-related medical condition or diagnostic hearing tests. The physician can find the cause of hearing loss with the help of these tests.
While you may believe that hearing aids are medically necessary, Medicare Part B does not cover most peoples costs. On the other hand, Part B covers cochlear implants and bone-anchoring hearing aids because they are classified as prosthetic devices rather than hearing aids by Medicare.
These are surgically implanted hearing systems that operate differently than standard hearing aids. For example, a BAHA is attached to the skull bone. Rather than amplifying sound, it directs vibrations to the inner ear, bypassing the middle and outer ears. In comparison, a cochlear implant placed surgically stimulates the auditory nerve via electrodes.
These devices can benefit individuals facing problems with their middle ear or ear canal, preventing sound waves from approaching the inner ear. Traditional hearing aids may not be as effective for individuals with this type of hearing loss.
Cover For Hearing Aids In 2020
Medicare Parts A so B shall not include hearing aids as of 2020. However, this could change because of a government bill currently under consideration.
The HR 3 bill reached by Congress in 2019 requires the government to control prescription drug costs, according to the Hearing Loss Association of America. If the Senate passes the bill, the lower-price benefits will cover hearing treatment, which may require hearing aids.
HR 3 has not yet passed the Senate, however, and it could not succeed in becoming law.
This legislation named the 2019 Medicare Audiologist Access and Services Act is also a step in the right direction for audiology services coverage and, potentially, hearing aids. The act is still to become law, though, and its fate is unknown.
Lawmakers and advocacy groups step in a better direction when it comes to hearing aids. Now, however, it is not clear if Medicare will amend its policies to cover those tools in the coming years.
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Does Medicare Pay For Hearing Aids Hearing Exams Or Balance Exams
Medicare will pay for diagnostic hearing and balance exams only if your health care provider orders it to see if you need medical treatment.
Your Medicare Part B is what covers the diagnostic hearing and balance exams, so if youâre enrolled in Original Medicare, you have this benefit.
In many audiology practices, a diagnostic hearing and balance exam can cost upwards of $100, so itâs quite nice that Medicare picks up the cost as long as your doctor orders it.
Unfortunately, Medicare does not cover hearing aids, hearing exams, or exams for fitting hearing aids. You do pay 100% for hearing exams and hearing aids, and this is where the real expenses come in.
A good set of hearing aids can often cost around $5,000. If you see an audiologist at a family-owned practice, youâre more likely to be met with payment options, such as being able to pay half up front and the other half after a couple months.
If financing is a real concern for you, always ask if there is any flexibility before denying yourself the gift of better hearing.
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.
- With many Medicare Advantage plans, you may need to use a doctor or audiologist in the plans 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.
Its 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, Im 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.
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Which Medicare Plans May Be Best For You If You Know You Need Hearing Aids
Original Medicare and Medigap plans do not cover hearing aids. So what type of plan may be best for you if you know youll need a hearing aid in the coming year?
If youre enrolling in Medicare and know youll need a hearing aid, you may want to look into a Medicare Advantage plan. In addition to offering the benefits of parts A and B, many Part C plans also cover additional services like hearing aids and other hearing care services.
- out-of-pocket maximum
- amount of coverage or coverage limits for specific services or items
Because of these variations, its very important to carefully compare several Part C plans before selecting one. This can help you pick one that best suits both your health and financial needs.
Before getting your hearing aid, check with the insurance company to ask how much of the cost will be covered. You can then use this information, along with the total cost of the hearing aid, to help estimate your out-of-pocket cost.
Remember that getting a hearing aid doesnt just include the cost of the device it also includes the exams and fittings. You may want to ask about this coverage and include these costs in your estimate as well.
How Do I Know If I Need Hearing Aids
Hearing loss can be gradual and subtle, so sometimes its hard to determine if its really gotten that bad. The best way to know if youd benefit from hearing aids is by having a hearing exam. Here are a few signs that it’s time to think about scheduling one.
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Everyone keeps telling you youve got the TV or the radio turned up too loud.
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Its hard to understand what people are saying when you cant see their faces.
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It often sounds like others are mumbling.
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Youre struggling to hear conversations in group settings like dinner gatherings or parties.
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Youre missing some of what the actors say in movies or at plays.
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You often have to ask others to repeat themselves.
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It can be hard to hear on the phone.
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Its become difficult to hear higher-pitched voices or sounds.
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You dont always hear the phone or doorbell ring.
To set up a hearing exam, contact your primary doctor or health care provider for more information or a referral, if necessary.
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What About Medicare Advantage
By law, Medicare Advantage must provide at least as much coverage as Original Medicare though it can come with additional costs and network restrictions. However, since Medicare Advantage is private insurance contracted through the federal government, the benefits of each individual policy are unique.
The good news is that many Medicare Advantage plans do cover hearing aids, although they may limit the maximum amount theyll pay and a deductible may also apply. Your initial hearing exam may even be free if you use an in-network doctor.
Copays for hearing aids vary dramatically among insurers, ranging anywhere from $0 to a few thousand dollars. For this reason, its important to examine and compare all available plans carefully before making your choice.
If you have Original Medicare and want to switch to Medicare Advantage, you can make the move during the annual;Medicare Open Enrollment;period from Oct. 15 to Dec. 7. During the Medicare Advantage Open Enrollment period from Jan. 1 to March 31, you can switch from one Medicare Advantage plan to another.
Costs Of Hearing Aids
Hearing aids are expensive. Thankfully, there are now over-the-counter devices you can buy cheaply, if you have mild hearing loss. However, it is still recommended that you see an audiologist to determine if these will help long term.;
Hearing aid costs can range from $1000 $4000. The costs can explain why many seniors do not benefit from hearing devices.
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How Is Hearing Loss Diagnosed
If you are having trouble hearing, see your health care provider. He may refer you to an ear, nose, and throat specialist to determine if there is a medical cause for your hearing loss. You may also see an audiologist for a hearing test. Hearing tests can help identify the cause of the hearing loss and also measure its severity.
Does Medicaid Pay Hearing Aids
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Medicaid could cover hearing aids, depending on your coverage and where you live.
Medicaid helps provide health care to individuals with disabilities, children, pregnant women, and people under a specified income level. Since both the federal and state governments fund Medicaid, each state’s coverage varies.
If you receive Medicaid and live in the following states, you may have coverage for hearing aids:
- Alaska
For limitations on coverage, see the Hearing Loss Association of America for more details.
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Scheduling Your Hearing Exam
Under Part B, you can expect to pay 100% of the cost for exams to get fitted for hearing aids and hearing aids. If you have the financial resources and are willing to pay for it, call your doctor or hearing loss specialist to schedule a hearing exam.
If you have a Medicare Advantage plan and hearing services are covered, then follow your health plans rules for scheduling hearing appointments. For example, dont call a hearing specialist directly if your Medicare Advantage plan requires you to go through a primary care doctor first for a referral. You might want to contact your Medicare Advantage or other health plan to see if it offers hearing exams and hearing aid discounts through a specific program.
If you belong to;Medicaid,;or any other program that may help cover hearing costs, then follow the programs instructions for accessing your hearing benefits or buying a hearing aid.
Which Plans Would Be Best To Cover All The Costs Of Hearing Aids
Along with Medicare Part C, Medicare Part B may cover diagnostic hearing exams. This is as long as your doctor or other healthcare provider orders your hearing exam. But here are a few things you should know:
- Medicare Part C;is a Medicare Advantage plan. Common Advantage plan types are PPOs or HMOs . Medicare Part C plans are provided by health insurance companies that have been approved by Medicare.
Original Medicare will pay a fixed amount each month to insurance companies that offer Medicare Advantage Plans.;These plans must adhere to rules set by Medicare.
Its always best if you compare Medicare Advantage plans because they charge different out-of-pocket costs. They also have different rules for how you can get services, and these rules can change each year.
- Medicare Part B;This part of Medicare covers services or supplies necessary for the diagnosis or treatment of a medical condition that complies with accepted medical practice standards.
Medicare Part B also covers preventive healthcare services . You won’t need to pay for your hearing exam as long as you get these services from a healthcare provider who accepts Medicare.
Some people automatically get;Medicare Part B . However, its important to note that you might need to sign up for Part B.
You will need to pay this amount every time you pay for your premiums. This is so for as long as you are covered by Medicare Part B. Plus, the penalty amount will increase the longer you go without Medicare Part B.
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How To Know If You Need A Hearing Aid
Although most hearing problems affect older people, there have been several cases of deficiencies with young adults, and in some cases, children.
The major problem when you need a hearing aid is that you may not immediately know you need one! It is a problem that graduates naturally. But there are signs that you need to observe to know if you should see an audiologist about your ears.
Signs such as hearing a ringing sound in the ears, and trouble hearing people speak over the phone are obvious red flags. If you need to pay closer attention before hearing what someone is saying or you need to increase the volume of a speaker before hearing audibly, then you may have started developing ear problems.
Note that hearing loss can be treated, but the hearing may not be restored. Thats where hearing aids and other types of procedures come in.
Getting Your Hearing Tested
Don’t wait to address your hearing health as the guidance is sorted out. Get tested by an audiologist, take an online screening test, or visit a hearing center that has licensed hearing health providers. Find a hearing aids guide at hearingloss.org.
Take advantage of hearing aid discounts. Costco offers its own brand of hearing aids and other hearing services. Drugstore chain CVS has opened 32 hearing centers in seven states, with plans to expand this year, a company spokesperson says. Single device costs range from about $400 to $2,500. Try a high-tech device that’s not a hearing aid. Hearing technology company Nuheara sells wireless earbuds that work with a smartphone app for about $300 a pair. Wearers can tune out background noise at restaurants, offices or outside and “control how they hear the world around them,’ says company co-founder David Cannington.
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How To Find Out If Your Insurance Covers Hearing Aids
Hearing aids can be costly, but not all insurance providers cover the cost of hearing aids or exams. To find out if your insurance covers hearing aids, check with your insurance provider; or you can check if your state is mandated to provide hearing aid coverage for adults and children. You can contact your health-care provider and get in touch with member services for more information about insurance coverage for hearing aids.
You may have a few additional questions about whether your insurance coverage covers partial costs, exams, or hearing aids. As part of your research, be sure to find out if there are providers in your area or if your health plan offers a separate benefit or allowance for hearing aids.
Its also a good idea to look into the requirements for age-related hearing loss or other criteria to qualify for certain types of coverage. Some benefit periods may also vary. You should also check the hearing aids duration and whether regular checkups are covered. Finally, check with your insurance provider to see what their benefit amounts allocate, since there are specific benefit caps or maximum amounts that the provider may cover.
How Does Original Medicare Cover Hearing Aids
In short, Original Medicare;doesnt cover hearing aids. Neither do most Medigap plans. You’ll likely have to pay out-of-pocket for hearing aids, fittings for the devices and routine hearing exams with this coverage.
While routine hearing exams aren’t covered, Original Medicare may cover more comprehensive exams when certain requirements are met. Medicare Part B provides 80% coverage for a diagnostic hearing and balance exam that your doctor or health care provider orders to see if you need medical treatment ;for example,;to determine appropriate surgical treatment of a hearing deficit.
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If you are eligible for coverage, youll be responsible for 20% of the Medicare-approved cost of the exam, plus your deductible if you havent already met it. Additionally, if your hearing exam is done at a hospital, your hospital copay also applies. If you have a Medigap plan, it might cover these coinsurance costs.
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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 . 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.
Other Options For Covering The Cost Of Hearing Aids
Here are a few other ideas that may offer help in paying for hearing aids:
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If you are a veteran, hearing aids may be covered by Veteran’s Affairs if you meet certain criteria. Once registered with the VA, make an appointment with an audiologist to determine your eligibility.
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Check out nonprofit organizations that help disadvantaged senior citizens pay for the cost of hearing aids, such as Sertoma, the National Hearing Aid Project and HearNow.
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You may choose to use your Flexible Spending Account or Health Savings Account to pay for hearing aids and batteries.
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Many companies offer financing options to stretch payments over a prolonged period of time instead of paying the full price upfront.
Millions of people suffering from hearing loss continue to go without help because of the high cost of hearing aids. Don’t let the cost be a deterrent for you. With the help of licensed Medicare expert, find a Medicare Advantage plan that helps minimize costs associated with these vital services.
Dr. Courtney Schmidt is a clinical consultant pharmacist and geriatric care expert. Since completing her Pharm.D. at the University of Florida., Dr. Schmidt has worked in multiple clinical settings and has served as an Adjunct Professor at the University of Central Florida.
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Hearing Aid Prices On Medicare
Theres no such thing as a Medicare discount for hearing aids. Hearing aids are costly, and you must be fitted for them by your audiologist. The average cost of a single digital hearing aid is $3,000 to $4,000. Some retailers offer hearing services. Their advertised prices are less than you might pay at an audiologists office. But even though these retailers, a pair of hearing aids can cost thousands of dollars.
This factor of cost is one reason only about;one in four adults;who could benefit from hearing aids has used them. Many people wait years before finally getting hearing aids. If you need help with the cost of your hearing aids, do an online search for assistance paying for hearing aids in your state.
Medicare Advantage Plans May Cover Hearing Aids
Now, back to hearing aids. Original Medicare wont cover these often-important hearing health devices, but there are Medicare Advantage plans and Medicare supplement insurance plans that do. Additionally, many Medicare Advantage plans will also pay for routine hearing-related exams and services.
What specific hearing health services and items are covered will vary by plan, so be sure to look carefully at the plans available in your area and to ask how coverage and costs work.
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Baby Boomers Destroyed Their Hearing Biotech Is Trying To Fix It
The Over-the-Counter Hearing Aid Act of 2017 may provide some help. Sponsored by Sens. Elizabeth Warren and Chuck Grassley , it allows individuals to buy certain types of hearing aids over the counter without prior approval from a health care provider. The Food and Drug Administration has until 2020 to propose new regulations for the law, and the devices likely wont be available to the public until 2021.
Will over-the-counter hearing aids actually help address the unmet need for these devices? That remains to be seen. It will depend on how much they cost and how good they are. They likely wont replace the prescription hearing aid market nor should they much like how drugstore reading glasses dont fully substitute for prescription lenses. Nevertheless, over-the-counter products serve an essential purpose: They provide immediate, low-cost relief to health problems that may not need more advanced treatment.
One concern with the over-the-counter approach is that some consumers may believe these hearing aids address their problems when they really should be seeking professional help.
Another approach that could make prescription hearing aids more accessible is through insurance coverage. The Seniors Have Eyes, Ears, and Teeth Act has been introduced in Congress for several years in an attempt to include hearing aids and, as the laws name suggests, vision and dental services, in Medicare coverage.