Insurance Benefits, Third-Party Vendors, and Your Hearing Health: Why Your Insurance May Not Be as Beneficial as You Think
Navigating the complexities of insurance coverage for hearing care can be challenging due to the multitude of plans available. We are here to help you understand your benefits better!
Medicare and Hearing Aids
It’s important to note that Medicare does not cover hearing aids or any services related to them. Confusion often arises from secondary plans associated with Medicare. While many of these plans offer some form of hearing aid benefit, it’s crucial to understand that these benefits are provided by the secondary insurance, not Medicare itself.
Understanding Your Hearing Aid Benefits
Hearing aid benefits are typically found under the Durable Medical Equipment section of your insurance policy. In some cases, these benefits are “carved out” and assigned to another payer. If your plan includes a benefit, it usually specifies a maximum payable amount—commonly between $500 to $2,000 per ear every 36 months—and may require prior authorization. The language describing these benefits can be vague. For instance, a plan might state that it “only pays for devices that adequately meet the needs of the patient.” The term “adequate” can be interpreted differently by you, your hearing care provider, and the insurance company.
The Role of Third-Party Vendors
Many insurance companies list benefits that are, in reality, just discounts through third-party vendors such as TruHearing or Nations Hearing. For example, UnitedHealthcare contracts with its own subsidiary, UnitedHealthcare Hearing (also known as EPIC Hearing). In these arrangements, the third-party vendor dictates the available hearing aid technology allowed, the price you pay, and the amount of hearing care provided. Payments are made directly to the third-party vendor and often the insurance company does not contribute to the purchase of the devices.
Limitations of Insurance-Provided Hearing Care
Insurance plans are primarily designed to manage costs and generate profit, often focusing strictly on the hearing device itself without considering the necessary follow-up care for successful adaptation. This means that even with benefits, quality hearing care may incur additional costs. It has been consistently shown that individuals achieve better results with hearing devices when they receive care from qualified providers. Moreover, the best technology tends to offer more advantages, such as environmental mapping for improved understanding in noisy settings. However, insurance companies often limit options to basic or mid-level technology, especially when working with third-party vendors that require selection from a specific formulary.
A Fundamental Flaw in the System
The core issue is that insurance is designed to make money, not to provide comprehensive hearing care. While a hearing aid benefit may seem advantageous, it rarely offers the level of technology and support most people need to effectively navigate demanding communication environments.
By understanding these nuances, you can make more informed decisions about your hearing health and the role your insurance plays in it.
Need Help Understanding Your Benefits?
Oliver Audiology & Hearing Aid Services is here to help you with every part of your hearing healthcare. If you have any questions, please contact us directly. We are proud to serve San Diego and the surrounding area.
