Hearing aids and insurance: It’s a complicated relationship, and almost every person’s situation is unique. To help shed some light on the topic, Dr. Carrie Meyer, AuD., Director of Clinical Programs at Amplifon Hearing Health Care, shares insights about how you can be an informed buyer, ready to make good decisions when it’s time to purchase or upgrade hearing aids.
When shopping for hearing aids, one of people’s biggest concerns is price. It’s not hard to see why — hearing aids are a big investment, with the typical costs of hearing aids ranging from $1,000 and $4,000—or more—per pair. While the technology, fitting, programming and aftercare all factor into the overall cost, it’s understandable to experience some sticker shock.
Many people count on health insurance to help mitigate the cost of medical care and devices. The only problem? For the majority of people, coverage depends on which insurance provider they are with and the details of their personal plan, which is usually obtained through their employer. That can mean the difference between having hearing aid coverage and not having it at all—and it’s not at all unusual for hearing aids to not be covered. To make things doubly complicated, the insurance landscape is notoriously confusing, making it a challenge to access the healthcare you want and need.
Regardless of what your insurance plan looks like, understanding your coverage and the hearing care options available to you is critical. To tackle some of the big questions around hearing aids and insurance, we spoke with Dr. Carrie Meyer, Director of Clinical Programs at Amplifon Hearing Health Care, who has more than 30 years of experience helping clients find the hearing care they need. Read Carrie’s advice and insights on understanding hearing aid insurance coverage and how you can make the most of your benefits.
Are hearing aids covered by insurance?
Dr. Carrie Meyer, AuD.: Whether or not your hearing aids are covered depends on what kind of insurance you have. Different providers and plans offer varying levels of coverage that could affect how much you pay, and in some cases, provide some financial assistance for hearing aids.
Does health insurance cover hearing aids?
Dr. Carrie Meyer, AuD.: Most health insurance does not cover hearing aids for adults. It almost always does for children, but not for adults. It is becoming a more competitive market; employers are becoming more aware of the impacts of hearing loss. For example, hearing loss impacts depression, falls and dementia, and the effects occur far earlier than you might expect. Generally, employer-based health insurance does not cover hearing aids. More and more health insurance plans are creating hearing healthcare benefits because they recognize that hearing loss affects whole-person health.
Does insurance cover hearing aids for anyone?
Dr. Carrie Meyer, AuD.: While private insurance doesn’t cover hearing aids for adults, most health benefit plans cover them or are required by state law to cover them for children. These requirements were put in place because of the negative effects that hearing loss has on children’s speech and language development, reading level, and academic success. Mandates vary by state for ages covered, amount of coverage and benefit periods, so review your state’s policies to determine coverage.
Are there other options for hearing aid financial assistance with employer-sponsored insurance?
Dr. Carrie Meyer, AuD.: If you have employer-sponsored insurance, you often have the opportunity to set up either a Flexible Spending Account (FSA) or a Health Savings Account (HSA) to set aside funds using pre-tax dollars for out-of-pocket medical expenses. Having money set aside can make a real difference when it comes time to pay for hearing aids. Here are a few details about these kinds of accounts:
○ Tax Advantaged: You can contribute pre-tax earnings to your account, and withdrawals are tax-free if used for qualified health care expenses.
○ Tax Deductible: You can deduct the amount you put directly into HSA from the income on which you pay federal income tax.
○ Flexible: You are able to deposit money directly to the account and control how much goes into the account up to a certain amount.
○ Plan-dependent: HSAs are only available to people with qualifying high-deductible health plans.
○ Stays with you: If you change jobs, lose coverage through your employer or retire, the money that’s in your HSA is yours to keep and stays there until you spend it.
○ Tax-Free: You will not be taxed on the money that is put into this account, or when you make qualifying medical purchases.
○ Flexible: You can decide how much to contribute to your FSA, up to a limit set by your employer.
○ Connected to your employer: If you change jobs, lose coverage through your employer or retire, you lose any money remaining in the account.
○ May or may not roll over: In some cases, if you do not use your FSA money, you lose it at the end of the year. However, your employer may allow FSA money to be rolled over (up to a limited amount), or you might be given a brief grace period to spend anything left over after the end of year.
Speak with your HR representative to determine which account(s) are right for you and set one up if you haven’t already. Because hearing aids fall into the category of medical expenses — yet aren’t covered by private insurance — the money stored in these accounts can be put toward offsetting the cost of hearing devices as well as paying deductibles, copays and other hearing healthcare-related costs.
Does Medicare pay for hearing aids?
Dr. Carrie Meyer, AuD.: Historically, traditional Medicare does not cover hearing aids. Medicare was created in 1965 by President Lyndon Johnson and was designed to cover catastrophic health needs. The reason hearing aids weren’t included was that most people weren’t expected to live long enough to need hearing aids. Medicare was to be used for hospitalization for catastrophic illnesses and since hearing loss is a chronic condition, it isn’t covered.
With the changes under the Affordable Care Act, we now have Medicare Advantage Plans and Medicare Supplemental Benefits. Almost 94% of all Medicare Advantage plans have some degree of hearing healthcare coverage. Some of these plans have really rich benefits and cover just about everything. Some of them offer $500, a flex spending card, or a discount program. When we know that less than 35% of people who need hearing aids are wearing hearing aids, any financial help is a benefit.
What are Medicare Advantage plans?
Dr. Carrie Meyer, AuD.: While they are associated with Medicare and must be approved by and meet standards set by the government, Medicare Advantage plans (Medicare Part C) are offered by private health insurance companies and take the place of traditional Medicare. These plans must provide the same level of coverage found in Part A and B, but also offer services not typically covered by Medicare, such as hearing, dental and vision.
What is a Medicare supplement?
Dr. Carrie Meyer, AuD.: While Medicare Advantage plans take the place of Medicare, Medicare supplement plans, or Medigap plans, are designed to be used in tandem with the coverage offered by traditional Medicare. These plans cover out-of-pocket expenses including copays, coinsurance and deductibles. They generally don’t offer coverage for ancillary medical services such as hearing, dental and vision. Medicare supplement plans are available from private health insurance companies in most states.
Does Medicaid cover hearing aids?
Dr. Carrie Meyer, AuD.: Medicaid usually does cover hearing aids, for both children and adults. Many people who qualify for Medicaid are medically complex and frequently have health conditions including hearing loss.
Who can apply for Medicaid hearing aids?
Dr. Carrie Meyer, AuD.: While Medicaid offers health coverage to low-income individuals with disabilities and complex medical issues, it also provides coverage for families and qualifying pregnant women and children. States are legally required to provide health insurance coverage to these groups of people, but each state decides its own income requirements, eligibility requirements and coverage benefits. Because of states’ ability to design and operate their own programs, Medicaid hearing aid coverage by state varies.
What other insurance covers hearing aids?
Dr. Carrie Meyer, AuD.: We basically have three buckets within the United States: We have employer-based plans; we have federal plans [like] Medicare, Medicaid; and then in the middle are those patients who don’t have an employer that provides insurance coverage … [and] don’t qualify for federal plans. They’re going to be in the health exchange. On the exchange, there are programs that you could purchase that have hearing aid coverage.
Health exchanges vary state by state … every state must have coverage available. There’s a variety of plans, everything from very basic to very full featured. Of course, the number of options and benefits you choose will affect the monthly premium you pay. The number and type of health plans available to you will depend on the state in which you live.
Finding insurance for hearing aids on the marketplace
Dr. Carrie Meyer, AuD.: The federally administered Health Insurance Marketplace® is a tool that allows people to shop and sign up for health insurance plans. Not only is the Marketplace used by the self-employed to find coverage, but it’s also where those who qualify can apply for federal programs like Medicaid and by small business owners through the Small Business Health Options Program (SHOP) Marketplace.
As with other federal programs, each state manages their health exchange differently. In most states, the federal government runs the Health Insurance Marketplace at HealthCare.gov; however, some states control their own Marketplaces at state-specific websites. State-administered health exchanges function differently, so the number of plan options and included benefits, including hearing healthcare, will depend on where you live. Review your state’s plans carefully to determine the extent and availability of hearing coverage.
What are your options if you don’t have insurance coverage?
Dr. Meyer, AuD.: Unfortunately in the U.S, if you don’t have health insurance coverage, the burden of paying for hearing aids falls on the patient. If someone is on a limited income and they don’t have insurance coverage, many of those people don’t get hearing aids because they simply can’t afford them.
While it can seem difficult for patients who don’t have insurance coverage or whose current plan doesn’t cover hearing care, there are options to make necessary support accessible:
● The Department of Veterans Affairs. If you are a veteran or have hearing loss related to your service, you may qualify for health benefits and coverage, including hearing healthcare. Speak with your local veterans benefit administrator to apply for benefits and hearing-related care services.
● Social Security. If your hearing loss and associated disability affects your ability to work, you may qualify for assistance through the Social Security trust fund. Review eligibility requirements at your local Social Security office.
● Gift of Sound. The Miracle-Ear Foundation’s Gift of Sound offers hearing solutions and support services at no cost to people who meet eligibility requirements and who are unable to use other resources like insurance. Review qualifications to determine if this is the correct solution for you.
Choosing the right hearing health insurance starts with determining what could affect your hearing loss now and in the future, then creating a strategy to treat it. Before choosing a plan, discuss your hearing healthcare needs with the following people:
Primary care physicians
Dr. Carrie Meyer, AuD.: Primary care physicians are truly coming into the forefront of this [because] they’re seeing people who they’ve had as patients for five, 10, 20 years being affected by dementia, being affected by falls with injury. That could be a conversation that you start with your primary care physician: ‘You know me. You know my health. Am I someone who’s at a higher risk for hearing loss?’
Not only can your primary care provider be a resource in understanding your hearing loss, but they can also provide insight into how your hearing loss might affect or be affected by other, whole-body health conditions.
Dr. Carrie Meyer, AuD.: We know that if you have hearing loss, you have almost 50% likelihood of having depression, that you are three times more likely to fall, that you have five times increased incidences of dementia. Your health also affects your hearing: If you have high blood pressure, if you have diabetes, if you have high cholesterol levels, if you have sleep apnea, if you have kidney dysfunction, any of those things are going to make you more likely to have hearing loss.
As someone who knows your health and medical history, meeting with your primary care physician is a great starting point for understanding how your hearing and physical health can affect your hearing loss.
Dr. Carrie Meyer, AuD.: As an audiologist, I always recommend that people see an audiologist as they begin their hearing healthcare journey. As a specialized provider of hearing health care, usually your health plan will cover a hearing evaluation with an audiologist. Of course, your copays or deductible will apply. If you’re over 50, you should have your hearing tested as part of your preventative health care. This will create a baseline so you can monitor your hearing as you age.
A hearing test may require a referral from your primary care physician, but meeting with an audiologist will help determine your levels of hearing loss and what kind of hearing support you may need for your lifestyle. In most cases, hearing aids are the treatment option for hearing loss.
Dr. Carrie Meyer, AuD.: That’s why we focus on hearing aids. For over 90% of all hearing loss, hearing aids are the only treatment option. Even for mild hearing loss, hearing aids are likely your best treatment option.
After you have established your hearing healthcare needs, it’s important to determine the extent of your coverage and how it can be used to meet those needs. Review your coverage options with the following people:
Your employer’s benefits representative
Dr. Carrie Meyer, AuD.: Most employers give you several health plan options. You should check which options provide hearing healthcare coverage … That may turn into a conversation with your employer [or] your HR representative [or] your benefits director. Investigate what benefits are available and look at those plans that might be better if you have a family history of hearing loss. If you’re somebody who is a hunter, a musician, or someone who loves snowmobiles and motorcycles… you’re going to be more prone to noise-induced hearing loss, so check your health plan.
With the help of your HR representative, review the coverage options available through your company plans and how these benefits can meet your health and lifestyle needs. Your benefits coordinator can be a useful guide in answering questions you may have and advising on what coverage options may suit you best.
If both you and your spouse can receive healthcare through your employer, you may opt to add them to your coverage plan. Compare the coverage options offered by each of your employers, as well as the associated copays and deductibles, and consider your hearing healthcare needs to determine which plans might be the best for you. Spousal healthcare coverage options vary depending on the employer, so speak with your benefits representative to discuss covering multiple family members with your plan.
Your insurance provider
Insurance coverage, discounts, mandates, coverage and plans are always changing. To determine what your specific plan offers, call your insurance provider and discuss your plan. Consider these questions when reviewing your plan:
● What is my health plan’s benefit for hearing aids?
● Do I need to go through certain providers to get my hearing aids?
● How does my plan handle payments with the hearing aid provider?
● Does my hearing loss need to meet specific criteria for me to qualify for benefits?
● Are there limits on my benefits for specific hearing aid models or technology?
Your provider will be able to provide clarity on the details of your specific plan and assist you in determining your coverage options and whether or how that coverage can be used to cover the purchase of hearing aids.
Dr. Carrie Meyer, AuD.: One of the things I think that people don’t understand is there’s a large range of hearing aids. There are some that are less expensive but still are very full-featured and have a lot of options. You can also consider the other end of the spectrum and spend quite a bit of money. I think the key questions [to ask] are ‘What is most important to me? What are my communication needs? How do I want the hearing aid to look? How much am I able to spend?’ A good provider will talk about all of those things. They’ll talk about your health, your insurance coverage and your budget. I wish my patients wouldn’t be embarrassed and I wish they would look me in the eye and say ‘My budget is really important to me.’ Then I can be aware and find you the very best option that also respects your budget.
Based on your work, hobbies and other current lifestyle factors, your hearing care professional (HCP) will recommend hearing aid options that also align with your lifestyle as well as your insurance coverage. Honestly examine your needs and which solutions will provide the best support for your hearing loss.
Be prepared for your hearing aid appointment
Before you meet with a hearing care professional to purchase hearing aids, prepare for the appointment by reviewing your health plan’s benefits. Then, you can discuss hearing aid options with your HCP while understanding what hearing solutions are available with your current coverage.
When you arrive to your appointment, verify your insurance benefit at the front desk. Check to make sure that hearing aids are a covered benefit so that there are no surprises about coverage.
Dr. Carrie Meyer, AuD.: I think the worst thing people do is they assume that they don’t have coverage. I always tell my patients to flip over your insurance card. Call the 1-800 customer support phone number. Maybe worst case scenario is what you’re already assuming: You don’t have coverage. Then we’re going to work with you and we’re going to find you something that fits your budget. But what if you do have coverage? Don’t assume you don’t have coverage; it’s easy to check.
And if you do have coverage, your HCP can adapt their recommendations based on your hearing needs and what’s covered by your benefit. Either way, you have an ally who will help you find the best way to treat your hearing loss while navigating the complicated landscape of insurance.
It’s important to remember that hearing care is not a luxury—it’s an essential part of being healthy and staying fully engaged in life. As science continues to explore the crucial role hearing plays in our whole-body health, insurance coverage continues to expand to cover this vital service.