Hearing Aid Insurance Coverage: What Questions to Ask and What to Avoid

2015-03-03

Most insurance companies still have exclusion policies in regards to hearing aids, meaning they will not cover hearing aids or anything hearing aid related like follow-ups, repairs and supplies. Some insurance policies do have coverage, but they have many restrictions and red tape.

Here are some things you need to know to be able to exercise your rights for coverage:

  1. Does your plan cover medical hearing exams?


You can find this out by looking at your benefits booklet or by calling the insurance customer service line. Be sure to ask them for benefit levels for a “diagnostic medical hearing exam.” Otherwise, they will tell you it’s not covered, as most plans do not cover routine hearing exams.

If you are a current patient or someone thinking of become a patient, we will do insurance checks for you free of charge whether or not you have an appointment scheduled.

  1. If you do have hearing aid coverage, ask about the maximum allowable payment.


This is the maximum payment the insurance company is willing to make toward your hearing aids.

  1. Ask if the benefits you’ve been quoted are in or out of network benefits.


Some insurance companies require you to go to an “in-network” provider to be covered. Other companies will charge you a higher co-pay or out-of-pocket cost if the provider you are seeing is out of network. Even if a provider is listed as “in-network,” call them and verify this, as sometimes the insurance companies do not update this list frequently enough.

  1. Get your benefits in writing.


It’s a sad fact that sometimes insurance companies do not honor their commitments to patients. We have experienced it in our office where we were quoted benefits over the phone and were told a patient had coverage only to later find out that the insurance company didn’t tell us the correct benefit amounts over the phone. Ask your insurance company to send you, in writing, what your current benefit levels are, especially if you’ve switched insurance carriers.

  1. Learn what Medicare pays for.


Medicare will pay for one medical hearing exam per year, but they don’t cover hearing aids. Recently, we’ve seen some Medicare Enhanced Plans from major carriers that do include a hearing aid benefit up to $500. If you have a Medicare supplemental plan, check with them to see if you do have a hearing aid benefit through the supplemental insurance. Most of the time, however, if Medicare does not cover a service the supplement will not cover it either.

Discount Groups—Not All Are Created Equal

Here are some things to consider when buying into discount groups that claim to provide hearing aid coverage. There are reputable companies that provide hearing aid discounts like Truhearing, EarQ, EPIC, and many others. All of them have pros and cons, and it’ll depend on what your situation is, as some offer longer warranty periods, others will have a deeper discount, and some will have a better selection of devices to choose from.

Here are some things you should know:

It’s illegal in many states to sell hearing aids through the mail (including Oregon).

Any discount company that offers you hearing aids through the mail and asks you to go see an audiologist to program them may be much less expensive, but it becomes problematic finding a provider to service them. In Oregon, we are forbidden from selling hearing aids through the mail, and when we do sell hearing devices, we’re required to have a follow-up appointment with you within a certain time period. This is to protect consumers from fly-by-night operations.

If you purchase hearing aids online or through the mail, the audiologist you ask to program them has no relationship with the manufacturer, may not be able to program the hearing devices due to software issues, and may be violating the law and putting their license at risk. So, you can see how it may be hard to get a provider to service them for you.

Some discount programs will limit you to purchasing from a specific brand or hearing aid type.

This is also problematic for patients. If your hearing loss requires something outside of the limited selection offered, then the discount program may not cover them.

It’s very important to discuss with a professional what your specific hearing needs are. Make sure that the program you choose has a network of audiologists they work with so you know where to go or who to ask question before making the big decision about purchasing devices. Remember that you have to wear these devices for hours every day; you should be able to ask an audiologist all the questions you have and get any concerns you have taken care of.

If you need help deciding which hearing devices are the best for your personal situation, call our clinic in Portland, Oregon at (503) 232-1845 to schedule an appointment for a free consultation. If you already had a hearing test within the past six months, there’s no need for another exam. If your test is more than six months old, ask to check whether your insurance will cover your hearing exam.

Contact us today for a hearing consultation.

919 NE 19th Ave
Suite 170N
Portland, OR 97232

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