People 65 or older or those under 65 with a disability qualify for Medicare. The federally funded program provides its members with medical coverage. People who want more coverage than Original Medicare can select Medicare Advantage (Part C) plans. The cost of each and what they cover will vary. Anyone experiencing hearing loss and who needs testing or devices for this purpose must know what each insurer offers for benefits.
Understanding Medicare Advantage Plans
Selecting a Medicare Advantage plan means choosing an insurer to manage all hospital and medical insurance coverage, or Part A and Part B, with Original Medicare. Advantage plans save people money because they bundle the traditional Medicare benefits with prescription drug coverage and other add-ons that may cost people much more if bought individually.
Advantage plans can include an HMO, PPO, PPFS, and more. Some require participants to choose doctors and medical facilities within their network. Others allow their members to keep or use the medical providers they prefer. Other variations can include the co-pay amounts, the need for referrals, and what services and treatment they cover.
Private insurers operate Medicare Advantage plans under the oversight of the federal government. The laws ensure that anyone taking part in the plan does not lose any of the benefits provided by Medicare.
Limited Medicare Hearing Coverage
Medicare Part B covers the cost of hearing tests, but the member must pay their annual deductible for the plan first. Approval for coverage of the hearing test by the insurer only occurs if the patient receives a referral to an audiologist by their primary physician. The patient must also cover their co-pay of 20 percent for the audiologist visit. Medicare does not cover the cost of fittings for hearing aids or pay for the device.
Selecting and paying for a Medicare Advantage Plan is the only option for participants who want help with the cost of hearing tests and devices. A Part C plan is not a requirement, but many have found it necessary to reduce their overall expenses. Almost one-third of people over 65 experience hearing loss. Preparing for this possible health concern by researching plans can help retirees and their families save money.
Additional Coverage with Advantage
Medicare Advantage Plans (Plan C) cover an annual hearing test and do not require a co-pay. Many of the plans also offer coverage for the fittings and the devices. The total coverage provided varies. All Medicare participants should review the options to determine what works best for their needs.
HMO plans often require participants to use an audiologist and other medical professionals in their network. The specialists may not operate in the immediate area of each patient. Travel concerns or lack of doctor availability may make it impossible to use enough plan benefits.
Other plans may have higher co-pays for the hearing aid fitting or cover only a portion of the cost of the hearing device. Additional restrictions can include limits on what devices they cover, or they may only pay for one device a year regardless of why the individual may need another.
Choosing an Advantage Plan
Medicare Advantage Plans offer many beneficial coverages like dental plans, vision care, and some prescription drug plans besides aiding those with hearing loss. To determine the best choice, research all the benefits each option provides. The savings from dental or prescription coverages through the provider may make up for paying more for a hearing aid.
Understanding the Enrollment Requirements
People becoming eligible for Medicare have an initial enrollment period when they can accept an Advantage plan. Enrollment is three months before turning 65 and three months after the month of turning 65. If someone selects an Advantage plan during this time, they can drop the plan for Original Medicare anytime over the following 12 months. After 12 months, they cannot return to Original Medicare coverage.
Annual enrollment periods enable those enrolled in a Original Medicare plan to choose an Advantage plan. This option includes anyone on Medicare for longer than the seven-month initial enrollment period. These enrollment times allow those who want to switch to a Part C plan to do so. They do not have a grace period like new Medicare enrollees. After choosing to go with a Part C plan, they cannot return to Original Medicare.
Additional Hearing Aid Funding
If Medicare Advantage co-pays or limits prevent the participant from affording a hearing aid, there are some options. Other options that can contribute include using funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA). Veterans' programs may cover the cost of testing, fitting, and the device. The coverage typically requires the patient to have military service-related hearing loss. State Medicaid programs also exist for Medicare recipients with limited financial resources.
Hearing loss affects many people over 65, and the cost of managing the health concern can overwhelm people living on a fixed budget or with limited income. Many senior advocacy groups and lawmakers continue to work towards offering more benefits for this concern. Medicare coverage and the benefits provided through additional programs change often. Every Medicare recipient should consider their current needs and review the options available annually to ensure they have the best protection possible.
