Health insurance and hearing aids are complicated topics, and just because you have medical insurance doesn’t mean you have a benefit that helps pay for hearing aids. Some insurance companies cover the cost of prescription hearing aids, some provide a limited benefit, and some provide none. It’s always best to check your benefits with your audiologist so you know exactly where you stand before getting too far into the buying process.

That said, a recent survey conducted by the Hearing Loss Association of America (HLAA) and HearingTracker asked approximately 2,000 hearing aid consumers how much they paid for their prescription hearing aids and whether their medical insurance helped cover some or all of the cost.

The survey showed only one in four respondents had insurance that helped pay for their prescription hearing aids, and less than one in 20 had full coverage from their insurance company. Specifically, 4.5% had full coverage, 20.9% had partial coverage and 74.4% had no coverage.

While that seems low, it’s much better than in the past. Data from 2008 showed only 13% received help from their medical insurance.

This survey also asked respondents how much of the cost of their prescription hearing aids their insurance covered. It revealed the average consumer with a plan that covers hearing aids received $1,257 per hearing aid from their insurance company.

Why Don’t Insurance Plans Cover Prescription Hearing Aids?

That’s a great question, and one for which there is no direct answer. Most individuals over age 65 have Medicare, which DOES NOT cover any of the cost of prescription hearing aids. It does, however, help cover the cost of a diagnostic hearing exam ordered by a doctor/primary care provider, after meeting your deductible.

Medicare Advantage plans sometimes include coverage for prescription hearing aids and hearing-related services, but be sure to understand these benefits carefully. Each plan is different. Some restrict the provider you can work through and coverage varies widely.

Commercial or Private Insurance

Insurance provided by an employer or retiree benefits may include coverage for prescription hearing aids. Typically, you need to meet a deductible, contribute a co-pay, and cover costs that exceed the maximum amount of your plan’s benefits. If you have a Preferred Provider Organization (PPO) plan, you have access to out-of-network benefits, meaning you can choose a hearing health provider outside of your insurance’s network.

Note that some insurances, including BlueCross BlueShield, United HealthCare, Humana, and (VSP), work with third-party administrators (TPAs) like TruHearing or United HealthCare Hearing (UHH) to provide discounted hearing healthcare benefits. This means you may have a benefit for prescription hearing aids, but the terms of use may not be as user-friendly as you think and benefits may be limited.

Ask Questions First …

Bottom line, don’t assume that you have a benefit that will cover some or all of the cost of prescription hearing aids. Ask questions first so that you’re not disappointed or surprised when you actually place an order for new prescription hearing aids. Be sure to read the fine print and understand the definitions of what’s covered.

For example, we’ve had patients whose Medicare Advantage plans stated they would pay for “new” prescription hearing aids. While it’s true that they will pay for new devices, the devices they will pay for are often basic entry level, not advanced technology. For individuals who wear more advanced hearing aids, this can be a step down from the devices they are currently wearing. Other plans promote “free testing,” which can be misleading because they are screenings which do not provide the diagnostic information needed to properly fit prescription hearing aids.

Our best advice is to contact us first if you are shopping for a different insurance plan that will cover prescription hearing aids. We have staff who are trained and experienced in helping patients with their insurance benefits, and who will be happy to check this for you.

If you already have a plan and are scheduling an appointment in anticipation of purchasing new prescription hearing aids, we can check your benefit and let you know what your plan covers.

And one other caveat, not all audiologists accept insurance as payment. Typically, big box stores do not accept insurance plans, so be sure to ask if the provider you are working with accepts yours.

At Associated Audiologists, we work with most medical insurance plans. We find that patients are more satisfied when they are aware of their insurance benefits, if any, and they understand their limitations. In addition, we are supportive of the recently passed No Surprises Act, and provide each patient with a good faith estimate so they are fully informed of any potential charges.

Remember, our trained staff can check your insurance benefits when you schedule an appointment with one of our doctoral-level audiologists.