Insurance for Tinnitus and Hearing Aids
We understand how confusing insurance can be. It is for all of us – especially when dealing with reimbursement for tinnitus and/or hearing services! These challenges are not for everyone, but we are here to help you get the most out of your benefits. We have a dedicated insurance team to help navigate and determine insurance for tinnitus and hearing aids.
Medicare does NOT cover treatment for tinnitus or hearing loss
Many Medicare supplement plans follow this same exclusion policy. Considering this, we charge $60 – $165 for a hearing test or $80 – $185 for a tinnitus evaluation which we need to perform to properly diagnose and make our recommendations. Full testing with a diagnosis and treatment plan requires approximately 60 – 90 minutes of our doctors’ time.
Medicare will pay approximately $38 for an annual hearing exam when it is prescribed by your primary care physician (PCP) as “medically necessary”. Even if you do not require a referral for other services, you must have one specifically for a hearing exam.
Since we are a “Non-participating Medicare Provider”, we can, at your request, submit to Medicare for reimbursement of approximately $38. (We must submit this with the referral from your primary care doctor and we can NOT solicit this referral on your behalf.)
If you have Medicare and will seek reimbursement for the hearing exam, it is advised that you speak with your doctor about obtaining a referral to us before your first appointment. You will be responsible for full payment at the time of your appointment. Medicare will reimburse you directly if the claim is approved.
Hearing Aid Coverage
According to the American Speech-Language-Hearing Association (ASHA), 20 states currently require health insurance companies to cover hearing aids for children. Those requirements don’t apply when it comes to adult hearing aid coverage. In some states, private insurance does cover hearing exams, but it typically does not cover hearing aids.
Currently, there are only five states that require insurance companies to provide coverage for hearing aids for both children and adults.
These are seen below:
New Hampshire
Connecticut
Rhode Island
Illinois
Arkansas
So why don’t most insurance providers include coverage for hearing aids? They’re not considered essential medical devices. Instead, they’re deemed “elective” – chosen, rather than urgently necessary.
The Trouble with “Elective” Coverage for Hearing Aids
More than 50 percent of people over the age of 75 suffer from hearing loss, and for these individuals, hearing aids are far from elective. Hearing aids are a lifeline, helping people with hearing loss communicate with loved ones, stay sharp on the job, stay safe in everyday situations, and stave off depression and cognitive issues as they age. They can improve a person’s quality of life, affecting nearly every aspect of their day-to-day routine.
When you consider how dramatically hearing aids can influence a person’s health and happiness, it’s difficult to understand how insurers could say that they’re inessential and not worthy of insurance coverage. Unsurprisingly, the issue extends beyond whether hearing aids are necessary or elective. It’s also about risk vs. reward.
Medicare and Medicaid Coverage for Hearing Aids
We’ve discussed the fact that it’s rare to find hearing aids covered by insurance provided by private lenders, but what about Medicare and Medicaid? In most cases, hearing aids aren’t covered by Medicare, the government health program for individuals ages 65 and up. That’s because Medicare typically covers services, not devices.
There are a few Medicare Advantage plans that include hearing aid coverage; however, traditional Medicare doesn’t include any hearing aid coverage whatsoever. In addition, tinnitus (which can sometimes be treated using hearing aids) is not recognized by Medicare as “medically necessary” to treat. It is also a non-covered diagnosis for devices with major insurance companies.
Medicaid, on the other hand, often covers hearing aids, with different standards for each state. Unfortunately, this coverage typically only includes young people. For example, the Medicaid programs in Colorado and Arizona only cover hearing aids for individuals under the ages of 20 and 21, respectively. Curious about Medicaid and Medicare coverage in your state? You can find more information about coverage by state through the Department of Health and Human Services.
We are not contracted with the following carriers
Medicaid, TriCare, VA Choice, Kaiser, Colorado Vocational Rehab.
Click here to schedule an appointment or give us a call for more information.
