Hearing loss is a fact of life for millions of Americans, yet U.S. health insurance plans provide spotty coverage for hearing tests, hearing aids, and the like. Here's all you need to know about why that is and what you can do about it.
Approximately 48 million people in the U.S. are living with some form of hearing loss, according to the National Institute of Deafness and Other Communication Disorders.
And although nearly 30 million of those Americans could benefit from using hearing aids, fewer than 10 million currently do.
As eye-opening as those statistics are, they're likely to become even more so in the coming years. A 2017 Johns Hopkins report predicts the number of U.S. adults with measurable hearing loss will just about double by 2060.
The question is: how will health insurance plans in this country cover the bills those 80 million or so Americans receive after they have their hearing tested or they go to buy hearing aids?
At the moment, health insurance coverage of hearing care is spotty at best. Some policies help people pay for hearing tests, hearing-aid fittings, hearing aids, and the like, but many do not. The same is true of Medicare and Medicaid.
Why is that? And what can you do if your health plan doesn't cover needed hearing treatments and services? Keep reading for answers to those questions as well as quite a few more.
The answer here is pretty obvious: hearing tests, hearing aids, and other types of "hearing care" help people who are living with some sort of hearing loss.
That's important because hearing loss can impact someone's physical as well as mental health if it isn't properly diagnosed and treated. It can impact their safety, too.
As is all too often the case when it comes to questions about insurance coverage, the answer to this one is "it depends."
In particular, it depends on what kind of health insurance you have. It also depends on whether you need your policy to cover a hearing screening or test, or if you need it to cover a hearing aid or cochlear implant. And it depends on your age, too.
For example, some job-based or employer-sponsored plans cover hearing tests and even hearing aids. Some plans sold through the "marketplace" set up by the Affordable Care Act (also known as the ACA or Obamacare) do the same, though the law doesn't require such coverage for adults. (It does, however, require these plans to cover hearing screenings for children up to the age of 21.)
As for Medicare and Medicaid, they also fail to address the issue with any real consistency.
A case in point: Original Medicare--Medicare Part A and Part B--partially covers diagnostic hearing tests if a physician or other care provider considers them medically necessary, but that's about it. If you want help paying for a hearing aid, you'll need a Medicare Advantage plan rather than Original Medicare--and even then you're not assured of such coverage. (Not all Medicare Advantage, or Medicare Part C, policies cover hearing aids.)
Medicaid coverage for hearing tests and hearing aids, on the other hand, varies from state to state. In other words, some states assist beneficiaries in both situations, some do so in one but not the other, and some provide no such help.
Additional information on all of the above can be found below, so continue reading if you'd like to learn more about how different forms of health insurance deal with coverage of hearing exams and hearing aids.
Actually, there's no "usual" about it. U.S. health plans cover hearing care in a variety of ways. That's especially true of how they tend to cover hearing aids.
Here are the most common ways health insurance plans help Americans pay for these often-pricey devices:
A couple of other things to keep in mind here:
It probably could go without saying, but you're far more likely to come across health insurance policies that cover the cost of hearing exams, screenings, or tests than you are to come across ones that cover the cost of hearing aids or cochlear implants.
Unfortunately, this is another difficult question to answer. That's mainly due to the general unwillingness of insurance companies to talk about why they do or don't cover specific types of health or medical treatments or services.
Still, it's easy enough to guess why insurers tend to be shy about helping policyholders pay for hearing aids, in particular.
First, there's the price. As you'll learn shortly, hearing aids are expensive. That alone is enough to scare most insurance companies away.
Second, there's the fact that insurers seem to look at hearing aids as being "elective."
And third, they see hearing loss as a fairly likely, rather than an unlikely, risk. After all, the older you get, the more likely you are you loose your hearing to some extent. In fact, more than half of people over the age of 75 experience hearing loss.
Don't take this to mean it's impossible to find health insurance that covers hearing exams, hearing aids, and other sorts of hearing care. It does, however, mean you may have to do some additional legwork, or even be a bit creative, if you plan to buy a private, Obamacare, or Medicare health policy.
For starters, look at your policy. You may have a printed document or you may have to go online and access a digital one. Whatever the case, read through it. It should tell you if it covers hearing exams, hearing aids, or cochlear implants. It also should tell you to what extent it covers those services.
If it doesn't, or if what you read while going through your policy documentation doesn't make sense, contact the insurance company. You can do this over the phone (scan your policy or even insurance card for a toll-free number that'll connect you with member services) or via email. No matter which method you choose, the resulting conversation should make it clear which aspects of hearing care your plan will and won't cover.
The good news: you're more likely to have needed hearing tests or hearing aids covered if you get your health insurance through an employer than if you get it through the Obamacare marketplace, Medicare, or Medicaid.
The bad news: that still doesn't ensure you'll gain access to such coverage.
Although it's not unusual for job-based or employer-sponsored health plans to cover hearing aids, hearing screenings, or other products and services related to hearing loss, it's also not common or typical.
Also, even if your job-based health plan covers hearing tests or aids, it may not cover them fully. Or it may only cover them after a doctor or physician says they're medically necessary. This means it might cover some or all of the cost of a hearing aid if an injury or illness causes your hearing loss, but not in other situations.
If you already have health insurance through an employer, review your policy for information about this kind of coverage. And if it's not clear? Ask your human resources or benefits manager.
If you don't have health insurance through an employer, ask about this type of coverage if a plan's ever offered to you. Specifically, ask what the plan covers when it comes to hearing tests or hearing aids, and also ask how fully it covers them. Ask, too, if the plan limits this coverage in any particular ways.
Although the Affordable Care Act requires all marketplace--and most private and small-employer--health insurance plans to cover 10 categories of "essential health benefits," hearing care for adults isn't among them.
Because of that, many of the plans sold through the federal and state marketplaces don't cover hearing aids or even hearing tests for those over the age of 21. Some do, though, so shop around and carefully weigh your options if you need to buy coverage in this way.
How about children? One of the 10 categories of essential health benefits mentioned earlier requires marketplace plans to cover hearing screenings for newborns all the way up to 21-year-olds. And not only that, but they have to cover them without charging copayment or coinsurance fees (even if you haven’t met your yearly deductible).
As was mentioned earlier, Medicare Part A and Part B, sometimes called Original Medicare, doesn't cover routine hearing exams, let alone hearing aids.
That's not to say Original Medicare never covers these tests or screenings. One exception is if your doctor or physician decides one is medically necessary. In such cases, Medicare should step in to help you pay for it.
Original Medicare also sometimes covers the cost of cochlear implants. These electronic devices provide a "sense of sound" to people who are profoundly deaf or severely hard-of-hearing. As with hearing exams, however, Medicare usually only helps pay for cochlear implants if they're medically necessary.
Don't look for Medicare Part A or Part B to help you pay for hearing aids, though. For that, you'll need to have Medicare Part C, which is otherwise known as Medicare Advantage.
Not only do these plans, sold by private insurance companies that have contracted with Medicare, cover pretty much everything Original Medicare covers, but some expand that coverage to include things like routine hearing exams and hearing aids, too.
Medicaid's Early and Periodic Screening, Diagnosis and Treatment program requires that states cover hearing services for all beneficiaries under the age of 21.
Specifically, state Medicaid programs have to cover the following for children enrollees:
As is the case with Medicare coverage of hearing care, Medicaid coverage of the services listed above usually is tied to a medical need.
What about adults? Unfortunately for them, how Medicaid covers their hearing tests and hearing aids differs from state to state.
While some states fully cover adult beneficiaries' hearing tests and hearing aids, some only offer partial assistance in those areas. Others provide no help, especially when hearing aids are concerned.
If you're on Medicaid and you're experiencing hearing issues, contact your local agency and ask if it can help you with one or more of the services mentioned here.
Without health insurance, you may have to pay as much as $250 or more for a hearing screening or test.
If that's too much for you, contact a few hearing aid vendors. Some offer free hearing assessments. Be prepared for them to pressure you into buying one of their products if you go this route, though.
With health insurance, you might pay nothing for a hearing exam. Most people will at least have to cover a copayment, though. This amount can be anywhere between $5 or $10 and $75, depending on your insurance company and your plan.
Hearing aids cost as "little" as $1,000 and as much as $3,500 or more.
That's just for one device, by the way. And according to AARP, 80 percent of wearers need two of them--which means you should expect to pay $2,000 to $7,000 or more if you need a pair of hearing aids and have no health insurance.
On top of those costs, there are batteries and repairs to consider, too. Repairs can run the gamut from cheap to expensive, but the price tags attached to batteries are more predictable. Expect to spend up to $150 a year for them.
If you thought hearing aids were expensive, just wait until you hear how much cochlear implants usually cost. According to the American Hearing Research Foundation, cochlear implants cost around $45,000. That includes the device itself, the surgery to implant it, and the rehabilitation that follows, but even then the price tag's a whopper.
Thankfully, most health insurance plans cover cochlear implants if a doctor or physician determines they're medically necessary.
Although it would be great if hearing aid insurance helped people pay for their first (as well as subsequent) hearing aid or aids, that's not often the case.
Instead, this type of insurance usually just helps people repair or replace their hearing aids.
As such, you typically can choose between policies that cover only repairs, only replacement, or both. That choice, along with the make and style of your hearing aids, determines how much you pay for coverage.
On average, hearing aid insurance costs about $300 per year. You might pay less than that if your hearing aid isn't of the highest quality, and you might pay more if it's a top-of-the-line model.
Another way to save money on hearing aid insurance is to buy a policy that only covers repairs, or only covers replacements.
Only you can decide if the cost of hearing aid insurance is worth it.
That said, one reason many people invest in it is the warranties that are provided to buyers of new hearing aids usually only last a year.
Also, as you've already learned, hearing aids are expensive. A lot of people like the idea of spending $300 a year on an insurance plan that could keep them from spending $2,000 or $3,000 if their devices are damaged, destroyed, stolen, or lost.
On a related note, like most electronic or technological devices, hearing aids don't last forever. In general, they last between three to seven years. Some models or styles have longer lifespans and others have shorter ones, but that's the average. Which means, of course, that your first pair of hearing aids probably won't be your last. Replacing them even once is sure to be costly, especially if you can't benefit from a health insurance plan's contribution, allowance, or discount.
Still, hearing aid insurance isn't your only option here. Some companies allow people to purchase extended warranties for their hearing aids. Depending on how much they cost and what they cover, they may be a better option than an insurance policy. Other options are available to people who have a financial need.
Should you decide hearing aid insurance is your best bet, make sure you know exactly what you're getting into before you signed on the dotted line. Look beyond your monthly or yearly payment. See if the policy you're considering limits its coverage in any ways that could make repairing or replacing your hearing aids more expensive, and more of a hassle, than you first thought.
There are two main providers of hearing aid insurance in the U.S. at the moment. One is Midwest Hearing. The other is Ear Service Corporation, or ESCO.
If your health insurance plan won't help you pay for hearing tests or hearing aids, or if you don't have a health insurance plan at all, check out the following organizations. They may be able to help.
The National Hearing Aid Project also helps Americans in need obtain hearing aids.
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