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The Hearing Aids and Medicare
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The Hearing Aids and Medicare

Published On: 18th November 2018
Last Updated On: 19th November 2018

The Hearing Aids and Medicare

Insurance are THE real life-savers. When health seems to crumble, insurance (if you have any) is always there to save you from the trouble, which in this case, debt from paying for your hospital or medical bills. So literally, they got your back when you have back pains.

 

Do take careful note on the fact that insurances come in different ‘packages’ or plans, regardless of what type of insurance is availed. This will benefit both the customers and the company, since packages help customers determine the availability of the insurance they’re paying for through,

1) Their salary and the percentage of their salary that will be allotted to the insurance.

 

2) The commitment of the customers to pay for their insurance fees, since different insurance packages offer different periods of time allowable to be paid.

 

In turn, the company is able to ensure the affordability of their insurance services to their customers while customers are able to avail insurances and pay for them according to their budget.

 

The variation in prices also means a variation in the benefits or insurance offers in plans or packages as well and an array of offers, each getting better or are offering more financial aid, are inclusive to packages as their prices get higher.

 

In simpler terms, the higher the cost of the insurance plan, the wider the coverage in financial assistance it offers. Which is why, if your budget allows, always aim for the bigger bread, as long as it seems practical to you.

 

The issue on health insurances for this matter do not differ at all. In any insurance plan, costs and coverage may differ, and most do not offer to pay for certain health services like weight loss surgery, adult dental services, cosmetic enhancement, and even some maternity services.

 

Medicare, in particular, also has exclusions. And if you’re wondering if Medicare covers up hearing aid expenses, the answers is NO. But before we discuss deeper into the why’s, what’s, and the possible alternatives you can ask for financial aid, let us first discuss about what Medicare is.

 

What is Medicare?

      According to their website, medicare.gov, Medicare is a federal health insurance program for the certain persons selected under certain qualifications, as below:

  •         People aged 65 or older
  •         Younger persons with disabilities (selected and qualified)
  •         Persons suffering from End-Stage Renal Disease (ESRD), a permanent kidney failure that requires dialysis or transplant.

Medicare is comprised of different plans and parts that help cover specific services:

Plans

  1.   Original Plan

According to senior g5.com, The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Most people who qualify for Medicare will want to enroll in both Part A (Hospital) and Part B (General Medical), which will be discussed later. Part B will cost you a monthly premium that varies based on your income.

  1.   Medicare Advantage Plan

The Medicare website states that this plan, sometimes called “Part C” or “MA Plans,” is offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. If you join a Medicare Advantage Plan, the plan will provide all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. This is different than a Medicare Supplement Insurance (Medigap) policy.

There are five different types of Medicare Advantage plans, as cited from the Medicare website, as follows:

  •         Health Maintenance Organization (HMO) plans—In most HMOs, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. You may also need to get a referral from your primary care doctor for tests or to see other doctors or specialists.
  •         Preferred Provider Organization (PPO) plans—In a PPO, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You usually pay more if you use doctors, hospitals, and providers outside of the network.
  •         Private Fee-for-Service (PFFS) plans—PFFS plans are similar to Original Medicare in that you can generally go to any doctor, other health care provider, or hospital as long as they accept the plan’s payment terms. The plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you get care.
  •         Special Needs Plans (SNPs)—SNPs provide focused and specialized health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.
  •         HMO Point-of-Service (HMO POS) plans—These are HMO plans that may allow you to get some services out-of-network for a higher copayment or coinsurance.

Parts

  •         Medicare Part A – Hospital Insurance

According to their website, Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

  •         Medicare Part B – Medical Insurance

This part covers selected doctors’ and preventive services, medical supplies and outpatient care.

  •         Medicare Part C – Medicare Advantage Plans

This type of health plan is offered by a company having contracts with Medicare. The first two parts (A and B) are provided by the Medicare Advantage Plans, as discussed above. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan, which aren’t paid for by the Original Medicare plan.

  •         Medicare Part D – Prescription Drug Coverage

Part D adds prescription drug coverage to the Original Medicare plan, some specific Medicare Cost Plans, Medicare Private-Free-Service Plans and Medicare Medical Savings Account Plans.

What are the health services that are not covered by Medicare?

      There are some health services that are just too costly to be covered by insurances. This would be a disadvantage to medical insurance companies because services and costs may differ from person to person.

 

Some of these services are considered an ‘elective’ to the company hence an exclusion to their services. The International Student Insurance website enumerates the services that are generally excluded by these companies:

  •         Pre-existing conditions

A pre-existing condition is any illness or injury that you had before the plans effective date. This includes anything that has exhibited symptoms or you have been treated for within a specific time period before the plan begins, and even conditions you may not be aware of.

If your pre-existing condition is considered excluded, you will not receive any benefits for related doctor visits, prescriptions, hospitalizations, etc.

  •         Dental and Vision

Of course, it would be convenient for both dental and vision to automatically be covered by insurance plans, but this is not always the case. In addition to traditional medical insurance, companies oftentimes sell plans specifically for dental and vision, or these benefits may be offered as an additional rider to an existing plan.

  •         Maternity

It’s important to verify the exact wording for both the coverages and exclusions for maternity, as they vary greatly between plans. Perhaps the delivery is covered but the pre-natal and post-natal care is excluded.

  •         Mental Health

Treatments for substance and alcohol abuse are common exclusions, as is suicide. While mental health can be considered just as important as physical health, it’s not always covered by traditional insurance policies.

 

Often required for international students by their college or university, it’s important to find a plan that covers an array of mental health conditions as a proactive measure.

  •         Outpatient Prescriptions

When you visit the doctor you may be prescribed medication to help the healing process of your injury or illness. Depending on the drug you need, this fee can take a good chunk out of your wallet so it’s important to verify these costs will be covered by your plan.

 

It’s also important to know how your prescriptions will be paid for since international plans often require you to pay for prescriptions out of pocket and then be reimbursed through the claim process.

So why aren’t hearing aids covered by Medicare?

      As mentioned earlier, some health services are considered as an ‘elective’ by medical insurance companies, meaning they aren’t ‘medically necessary’. Medically necessary treatment is defined by Medicare.gov as ‘health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine’.

 

Medicare does cover some health services to be availed by persons planning to purchase hearing aids, which is just about 80 per cent of the diagnostic test to be performed by your physician if deemed necessary. Only 20 states in whole United States of America cover a portion of the expenses for hearing aids, mostly exclusive for children only.

However, hearing loss is a serious medical condition that will affect all aspects of a person’s life. According to healthy hearing.com, hearing aids are a lifeline to people suffering from hearing loss, further explaining this by emphasizing what could be at risk without the device: family relationships, employment to mental and physical health, as well as their own personal safety.

The controversy on insurance companies excluding hearing aids from their services still remains a speculation. healthyhearing.com feedbacks on the issue, as follows:

The arbitrary nature of declaring a medical device elective is certainly convenient for insurance companies. Meanwhile the real reasons insurance companies don’t cover hearing aids, while a closely guarded secret in the insurance industry, are wide open to be speculated upon. And like many things, the reasons are most likely fiscal.’

Bottomline, the reasons behind this exclusion remains unknown but most likely it is to keep the advantage to these insurance companies.

Where can we find financial aid then?

      AARP.com provides a list on where you can seek financial aid to cover for your hearing aid fees.

  •         Medical flexible spending accounts. For those with these accounts, the cost of a hearing aid and batteries is considered reimbursable.
  •         Medicare and Medicaid. Hearing aids and most hearing tests are not covered by Medicare. Medicaid may cover hearing aids, but each state’s requirements differ. The Hearing Loss Association of America’s website has information by state.
  •         Veteran benefits. Vets get hearing aids if their hearing loss is connected to their military service or linked to a medical condition treated at a VA hospital. Veterans also can get devices through the VA if their hearing loss is severe enough to interfere with activities of daily life.
  •         Federal employee assistance. Federal employees and their families are entitled to coverage through some insurance plans. Health plans pay for a basic hearing aid, and employees pay for extras and upgrades themselves.
  •         Nonprofits. Sertoma helps people with hearing problems and runs a hearing aid recycling program, SHARP through its 420 clubs. HEAR Now, sponsored by the Starkey Hearing Foundation provides hearing aids for people with limited income. Clients pay for evaluations and a fee of $125 per aid.
  •         Private insurers. Few private insurance companies cover hearing aids, but three states — New Hampshire, Rhode Island and Arkansas — require that insurers provide coverage for adults.

 

New Hampshire insurance companies are required to cover the cost of no less than $1,500 per hearing aid once every five years. Rhode Island requires individual and group insurance policies to provide $700 coverage per individual hearing aid every three years for those over age 19.

 

And in Arkansas, insurance companies are required to offer coverage to employers in the state. If a company takes advantage of this, the health plan must provide coverage of no less than $1,400 per ear every three years

  •         Affordable Care Act. A few states include some coverage for hearing aids and related services, under their health insurance exchanges. Information about this coverage is available from the Hearing Loss Association of America and through the Department of Health and Human Services.  This government site gives additional information on proposed essential health benefits benchmark plans by state.
  •         Health Savings Accounts (HSA). As with FSAs, these types of accounts cover the cost of hearing aids and batteries. Unlike FSAs, money in your HSA accumulates from year to year, allowing you to save toward the cost.
  •         Health Reimbursement Accounts (HRA)

It’s up to your employer, who funds this type of account, to decide if hearing aids and batteries are reimbursable. Check with your company’s benefits department.

 

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