health insurance claim form on desk with stethoscope, hearing aid, and pen
HEARING AIDS

Hearing Aids and Insurance: Navigating the Maze

BY JACKIE DOUDA - NOVEMBER 16, 2023

 

 

Hearing loss can be a daunting experience, and, for many, it's a challenge that's often compounded by the complexities of insurance coverage. With recent efforts by Congress and the FDA to make hearing aids more accessible and affordable, understanding your insurance options is crucial. In this informal guide, we'll break down the intricacies of insurance coverage for hearing aids in the United States.

The Hearing Aid Conundrum

Hearing aids can be a lifeline for those with hearing loss. They provide the gift of sound, connection, and improved overall well-being. However, despite their importance, the adoption rates for hearing aids in the US have been relatively low. Several factors contribute to this, including the stigma surrounding hearing loss, the cost of hearing aids, and the difficulty in accessing necessary care. In other countries, we have observed that adoption rates rise when health insurance covers most of the hearing aid costs. Unfortunately, in the US, it's not that straightforward, as Original Medicare (Medicare Part A/Part B) and many commercial plans do not cover hearing aids.

closeup of health insurance form on clipboard at doctor's office

Who Covers Hearing Aids?

The big question is, who does cover hearing aids? If you're enrolled in a Medicare Advantage plan, have insurance through a large employer, are an active or retired federal employee, or belong to a union, you may have some form of coverage for hearing aids. However, the specific coverage and options vary depending on your plan.

Medicare Advantage Plans

Many Medicare Advantage plans offer hearing care and hearing aid benefits. But there's a twist. You usually need to access these benefits through a hearing benefits manager; examples include TruHearing, Hearing Care Solutions, UnitedHealthcare Hearing, or NationsHearing. The availability of providers and products depends entirely on these benefit managers, who are responsible for selecting the providers and products eligible to be covered by these benefits, meaning that your choices might be limited. You might also be offered a fixed dollar allowance or a series of co-pays based on the hearing aid you choose. As of November 2023, despite the final OTC hearing aid regulations, most Medicare Advantage Plans do not cover OTC hearing aids such as Eargos.

We are starting to see some progress: for example, in 2024, UHC Hearing plans are expanding their benefits to include OTC hearing aids. However, to date, most Medicare Advantage plans have not expanded their coverage options..

Large Employers

Large employers often offer more flexibility when it comes to benefit offerings. Many of them provide an allowance for hearing aids. Unlike Medicare Advantage plans, most large employers don't differentiate between prescription and OTC hearing aids. However, they might require you to have an in-person or telehealth visit with a hearing professional to get a hearing test and diagnosis of hearing loss as a condition of coverage.

Active or Retired Federal Employees

The Federal Employee Health Benefits (FEHB) Program has long offered plans that cover hearing care and hearing aids. These plans usually provide a benefit allowance that can be used to purchase hearing aids from any provider. However, not all plans cover OTC hearing aids, and some may require prior authorization. To help you better understand the types of coverage provided by some of the most common FEHB Plans, we’ve put together a comparison chart here:

2024 Hearing Benefits By Federal Health Benefits Carrier
For informational purposes only; Published as of Nov 13, 2023

Plan Name

Are Hearing Aids Covered?**

How Much Will The Plan Pay Toward Hearing Aids?**

How Often Can the Benefit Be Used?

What Does the Plan Say About Over-The-Counter Hearing Aids?

Are Hearing Aids Available Without Prior Authorization?

Link to Plan Brochure

BCBS FEP Standard and Basic Plans

$2,500

Every 5 years

🗙

OTC hearing aids excluded from coverage

🗙

Payer requires prior approval to utilize $2,500 hearing benefit

BCBS FEP Standard and Basic

GEHA High, Standard, and Elevate Plus Plans

Up to $2,500

Every 36 months

🗙

OTC hearing aids excluded from coverage

GEHA High and Standard

 

GEHA Elevate Plus

MHBP Standard, Value, and HDHP Plans

Up to $2,000

Every 5 years

The plan brochure doesn’t differentiate between prescription and OTC hearing aids

MHBP Standard & Value

 

MHBP HDHP

Aetna Federal Rural Carrier, Foreign Services, and Direct Plans

Up to $4,000

Every 3 years

Aetna Rural Carrier

 

Foreign Svcs

 

Aetna Direct

NALC High Option Plans

$2,500

Every 3 years

NALC High

APWU High Option and CDHP Plans

$1,500

Every 3 years

 

APWU

Aetna Federal Saver, HDHP, CDHP Plans

🗙

 

 

 

 

 

HDHP/CDHP

BCBS FEP Focus Plans

🗙

 

 

 

 

BCBS FEP Focus

GEHA Elevate and HDHP

🗙

 

 

 

 

GEHA Elevate

 

GEHA HDHP

**We will perform an insurance verification of coverage and benefits and will communicate what we learn about your health insurance hearing aid benefit and your expected financial responsibility.  However, a verification of benefits from your insurance is not a guarantee of coverage or payment.  Health insurance plans do not always reimburse or pay for the cost of a hearing evaluation or hearing aids, even when you or your health care provider have reason to think you need the hearing aids.  We will not know your insurance company’s coverage determination until it processes the insurance claim.

Active or Retired Union Members

If you're a member of a union or receive health insurance through your union benefits, you may have coverage for hearing aids. This includes various professions like first responders, trade unions, teachers, and autoworkers. Similar to large employers, most of these health plans don't differentiate between prescription and OTC hearing aids, although they might require you to have an in-person or telehealth visit with a hearing professional to get a hearing test and diagnosis of hearing loss as a condition of coverage.

doctor and patient looking at a hearing aid together

Take Action to Understand Your Coverage

If you're navigating the insurance maze for hearing aids, here are some steps to consider:

  1. Review Your Plan Documents: Understand the details of your insurance coverage. If you need to call a benefit manager to access your benefits, inquire about out-of-network options and compare the costs to make an informed decision.

  2. Contact Your Health Plan or Employer: Reach out to your health plan or employer to explore the possibility of Eargo becoming an in-network provider or having benefits cover OTC hearing aids.

  3. Talk to Eargo: Contact Eargo and provide your insurance information, and Eargo can assist you in verifying your hearing aid benefits and whether they can be used to purchase Eargo devices. You'll also learn if a hearing test is necessary before coverage can be applied.

Insurance coverage for hearing aids is a complex web, but with the right knowledge and some proactive steps, you can find a hearing aid that works for your hearing loss. Don't let insurance barriers prevent you from improving your quality of life through better hearing. It's time to explore your options and make informed choices.