Hearing aids are traditionally expensive and Medicare hearing care coverage is limited. Changes are being implemented to make hearing aids more affordable.
Medicare is a federal health insurance program that provides benefits to American citizens and permanent legal residents aged 65 and older, or who have a qualifying disability or illness. It works on different types of medical coverage (referred to as parts), based on the individual’s health status. Most people are automatically enrolled in Medicare – once eligible.
Medicare Coverage Parts
The original Medicare coverage consists of Part A which is hospital insurance and Part B which is medical insurance. In addition, we look at the additional options such as Part C, Part D, and Medigap; to further determine the Medicare coverage for hearing aids in 2020 (Medicare, 2020).
Medicare Part A is hospital insurance. It covers services like inpatient hospital stays, care at a skilled nursing facility, and hospice care. Part A does not cover hearing aids (Medicare, 2020).
Medicare Part B covers outpatient services, like doctors’ appointments. It is also used to pay for selected services or devices if they are medically required, which includes types of preventive services. Medicare Part B does not cover the cost of a hearing aid or the exams that are required to fit one. However, Medicare Part B does cover diagnostic hearing assessments if you are referred by a medical doctor for a hearing assessment. In this case, you would be liable to pay 20 percent of the Medicare-approved cost (Medicare, 2020).
Medicare Part C, also known as Medicare Advantage plans, are offered by private insurance companies approved by Medicare. These plans provide the benefits covered in parts A and B and may include additional coverage. The additional coverage provided can include hearing benefits, which can include the coverage of hearing aids. The costs and coverage will vary based on the individual’s health status and coverage plan.
Part D is also offered by private insurance companies to cover the cost of prescription drugs. This too does not cover the cost of hearing aids.
Medigap is also known as supplement insurance. Medigap plans are provided by private companies to help cover costs or services which are not covered by parts A and B. However, Medigap does not typically cover hearing aids.
It is estimated that hearing loss affects two-thirds of people over the age of 70, yet even the basic Medicare parts do not seem to address this challenge.
Research conducted by Frank R. Lin, M.D., Ph.D., and colleagues at Johns Hopkins University, has been developed to establish the need for Medicare coverage of hearing aids to prevent the consequences of hearing loss (Copithorne, 2019). This research has shown that:
- Hearing loss affects nearly 48 million Americans and, if left untreated, “has serious emotional, social, and medical consequences for older adults.”
- Older adults with hearing loss are 32% more likely to require hospitalization, face a 24% increased risk for cognitive impairment, and increasingly suffer from isolation and depression.
- A 10-year longitudinal Johns Hopkins study found that patients with hearing loss had a higher probability of developing dementia, with the probability rising as the severity of hearing loss increased.
Why are hearing aids not covered by Medicare?
Medicare was established in 1965, a time when there were hearing aids available, but these technologies were not as defined as the options we have today. The hearing aids were considered a device that was occasionally required (not deemed a necessity) and inexpensive to purchase. Modern developments in technology have led to the increased price of hearing aids but also the value that hearing aids have to offer. Hearing aids are now seen as an essential device for communication and functionality. In addition, there has been an improved understanding of the comorbidities associated with hearing loss, which again highlights the need to wear hearing aids.
Current research has shown that hearing loss has been linked to dementia, balance disorders, depression, and cardiovascular disease. Furthermore, there have been pandemics such as HIV/AIDs and other related conditions (TB) that have led to an increase in the rise of hearing loss amongst other conditions. In addition, people are shown to be living longer which leads to the focus of quality of life, of which hearing is an essential requirement (Ciorba, Bianchini, Pelucchi, & Pastore, 2012).
Medicare’s coverage includes a diagnostic hearing assessment to determine the cause of other conditions but is not aimed at treating hearing loss directly. For example, your doctor might test to see if hearing loss is causing imbalance or vertigo. The results of a diagnostic exam may signal that you have hearing loss, but that will not cover the payment for a hearing aid (Engle, 2020).
Many people would like to see Medicare evolve to cover dental, vision, and hearing care. A Commonwealth Fund report details the financial and health burdens these gaps place on older adults (Victory, 2020). The report said: “Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one.”
What does the legislation say?
Over the past few years, legislation has been introduced in Congress that would expand Medicare coverage to hearing aids. These include the Medicare Hearing Aid Coverage Act of 2017 (H.R. 4618), passed by the House Energy and Commerce Committee. It amends the Social Security Act to provide insurance coverage for hearing aids and hearing health services under Part B of the Medicare program.
In addition, it ensures seniors and people with disabilities on Medicare have access to a full range of hearing and balance health care services provided by licensed audiologists. It also eliminates the requirement that patients get a referral from a medical doctor prior to accessing audiology services.
Similarly, the Seniors Have Eyes, Ears, and Teeth Act has also been introduced to provide Medicare coverage for vision, hearing, and dental care. The legislation has passed the House Energy and Commerce Committee but will need to be approved by the House and the Senate before it can become law.
The high cost of hearing aids has attracted the attention of Congress, and there are changes in the works that could make hearing aids more affordable for everyone. In 2017, Congress passed legislation instructing the Food and Drug Administration (FDA) to ease barriers to buying hearing aids. Since then, the FDA has been working to approve the sale of over-the-counter hearing aids. The new hearing aids, available in 2020, will be self-fitted, rather than professionally fitted by an audiologist. They will cater for persons with mild to moderate hearing loss (Engle, 2020).
The Medicare Hearing Act of 2019 includes the following limitations for coverage:
- Medicare will only pay for one pair of hearing aids every five years
- Coverage will only be provided to those with severe-to-profound hearing loss
- Over-the-counter hearing aids are not covered
- A written order from a doctor or qualified audiologist will be required (Copithorne, 2019)
This is only the first step in a long legislative process, and with it comes coverage limitations, however, it is a step closer to where hearing health care needs to be. With 10,000 Baby Boomers turning 65 every day, it comes at a time when lawmakers are increasingly aware of the growing problem of hearing loss in the U.S. population (Copithorne, 2019).