Fall is the time for open enrollment in employer-sponsored insurance plans, as well as Medicare and Medicare Advantage plans. Be sure you understand your plan’s benefits, especially as they relate to prescription hearing aids.
Ahhhh, fall. It’s the time of year when the air becomes crisper, the leaves change colors, and yes, you’re bombarded with endless pitches to change health insurance plans. Here are a few tips to help you sort through the many choices you have, especially as it relates to prescription hearing aids.
Employer-sponsored Plans
Typically, if you have employer-sponsored insurance, there will be an open enrollment period from late October to early December in which you may be able to make changes to the plan you choose for the coming year. Usually, these changes may include switching from low to high-deductible plans, or vice versa, or plans with richer benefits. In some cases, the plans offered may include a benefit for the purchase of prescription hearing aids.
If you’re trying to decide which plan is the best option for you and you think you may need new hearing aids in the coming year, be sure to contact your audiologist’s office and check to see if they accept the plan you’re considering. If they do, find out what the plan does or doesn’t cover. Often, you will have to meet your plan’s deductible before coverage kicks in, but remember that every plan is different.
Some insurance companies also promote “discount options,” which may be purchased through a third party. Be sure you understand exactly what your plan offers. Often, these “benefits” or “discount options” limit you to the purchase of a specific device from a specific provider or manufacturer. They may offer a lower cost for the device only, which doesn’t include service; provides only low-end devices that may not work well for your specific hearing needs; or offer limited flexibility for the patient. In some cases, you can purchase devices of your choice with included service for the same or less than these “discounted options.”
Bottom line: Don’t rely on what your co-workers tell you, or even what the insurance company says. When it comes to prescription hearing aids, check with your audiologist before you sign up for a new plan. That’s the only way to verify your plan’s benefits as they relate to hearing aids.
Medicare
The annual Medicare open enrollment period runs from October 15 to December 7 each year. During this time, people with Medicare can review the features of the supplemental Medicare plans offered in their area and make changes to their coverage, which go into effect on January 1 of the following year.
These changes include switching from traditional Medicare to a Medicare Advantage plan (or vice versa), switching between Medicare Advantage plans, and switching supplemental (Medigap) plans.
Medicare allows a comprehensive hearing evaluation when medically necessary. However, Medicare DOES NOT have any provision to help cover the cost of prescription hearing aids at this point, or anything related to hearing aids, or costs associated with hearing aids, such as batteries, services, or repairs. If you have Medicare and a traditional supplemental policy, you may have to cover the cost of hearing aids yourself as an out-of-pocket expense.
Bottom line: Medicare DOES NOT offer coverage for prescription hearing aids. If you need new hearing aids, be sure to discuss private-pay and financing options with your audiologist.
Medicare Advantage Plans
You can sign up for a Medicare Advantage plan during the same time frame as you sign up for Medicare/supplemental plans. Advantage plans offer the benefit of one-stop shopping (i.e., people who enroll have coverage under one plan and do not need to sign up for a separate Part D prescription drug plan or a Medigap policy to supplement traditional Medicare). These plans are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and usually Medicare prescription drug coverage (Part D).
Medicare Advantage plans can also have different rules for how you access services, like whether you need a referral to see a specialist. Or they may require you to go to doctors, facilities, or providers/suppliers that belong to the plan network.
Even though some Medicare Advantage plans claim to offer a hearing aid benefit, you should be fully educated about how this works. In our experience, sometimes the prescription hearing aid benefit covers only a low-end hearing aid that may be less sophisticated than some of the older hearing aid technology a patient may already be wearing, or the hearing aid they will cover is not appropriate for the type of hearing loss the patient has.
In other cases, the plans are so restrictive in terms of providers or treatment choices, the prescription hearing aid coverage turns out to be of little benefit. For patients who have purchased these plans thinking they now have coverage, not only for prescription hearing aids, but other services, like dental or vision, this can be very frustrating.
Bottom line: Before you sign up for an advantage plan, check the benefits very carefully as they relate to all your healthcare services. In some cases, the hearing aids they offer are mail order devices and in others, they have very few providers enrolled to provide coverage, causing confusion and delays for beneficiaries who want to utilize their benefit.
Questions?
Before you choose any insurance plan, contact one of our clinics to verify we accept the plan you are considering and that it has a prescription hearing aid benefit.
