My Insurance Doesn’t Cover Hearing Aids. Now What?

by Dr. Jennifer Stinson

The purpose of this article is to inform the consumer of questions to ask when deciding whether to purchase a plan to cover hearing aids and when it may be beneficial to pay out of pocket.  If you find yourself in an audiology office and are ready to purchase hearing aids, you may want to ask some of the questions explored below as well.

When you are over the age of 18, Pennsylvania Medicaid doesn’t cover the cost of hearing aids. However, several Medicare/Medicaid supplement plans do cover hearing aids. Most customers don’t know that many of the extra benefits these insurance plans offer are also offered when you pay out of pocket for the hearing aids. If you are in a reputable office that is bundling their prices it’s common to have an extended and complimentary trial period, free batteries, at least five years of in-office service, and an extended warranty of 2-3 years on the hearing aid.  Often these plans list extra benefits as something you are getting because you have their plan. When reading these “extras,” it seems as though they are giving you something beyond what you would normally receive if you purchased the hearing aids out of pocket. As a consumer who has never purchased hearing aids, this may seem like a great deal. There are some things to consider when signing up or paying extra for this benefit if you are doing so because you plan to purchase hearing aids. Some of the things to think about is:  Where are you able to use your benefit?  Will you have access to an audiologist who can adjust your hearing aids?  Is your insurance going to cover additional visits to your audiologist?

Most insurance plans require you to go to a specific office for your hearing aids.  This takes the freedom of choice away from the consumer and may put limits on your satisfaction of the care you receive.  For example, this office may not be near your hometown. You may need to travel to get to one of these offices, and you may also not be happy with the provider you are assigned to in that office. As I talked about in previous articles, you can either buy a hearing aid from a dispenser or an audiologist. Regardless of whom it is the insurance is sending you to, it’s important that you have a positive experience and you trust they have your best interest at heart. The average person will have their new hearing aid for five years before replacing them. You want to make sure you buy them from someone who you want to go back and see for follow up appointments during that time frame.  Follow up appointments are usually a few times a year for cleaning, reprogramming based on changes in your hearing needs, cleaning wax out of your ears, and minor in-house repairs of the hearing aids.

Your insurance plan may also offer a hearing aid that you purchase over the internet.  If they offer that as an option, you may want to ask some details about the follow-up appointments.  Some examples are: will you have access to a local audiologist to help you if you need the hearing aid reprogrammed, cleaned, or if you have questions regarding use and wear of the hearing aid?

Lastly, you will want to consider whether or not the insurance is going to cover the cost of visits to the audiologist after your trial period.  It is a state law in Pennsylvania that you have at least a 30-day trial period with hearing aids. The law states that if you return the hearing aids within that 30 days, you are required to get your money back. The office you purchase them from is allowed to keep 10% of the cost up to $150.00.  Your insurance plan may state that they allow you an extended trial period, sometimes 45 days, with the option for a full refund. To be honest, often times you would receive that regardless of having an insurance benefit. It is an advantage to have this option. However, you want to make sure the insurance is going to pay for visits beyond that 45-day trial period. As I discussed above, it is common to go back for follow up visits in the years after purchasing the hearing aids.  As an audiologist, I want consumers to be informed as possible when making these important decisions about their hearing and quality of life.  If you or someone you care about is ready to try hearing aids, please consider the information and questions listed above to make as informed a decision as possible.

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