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– In this post, I’m talkin’ about the basics of insurance when it comes to hearing aid coverage. Comin’ up. (chill music) Hi guys, Cliff Olson, Dr. Of Audiology and founder of Applied Hearing Solutions in Phoenix, Arizona and on this channel, I cover a bunch of hearing-related information to help make you a better informed consumer. So if you’re into that, make sure you hit that subscribe button. And don’t forget to click the bell to receive a notification every time I post a new post.
Contrary to popular belief, there are insurance plans that do provide coverage for hearing aids and hearing aid related services. But not all plans are the same. Different plans will have different amounts of coverage for hearing aids and the services that are associated with those hearing aids. So I wanna provide you with a little basic understanding of the different types of insurance so you can better understand yours. In general, you have seven different types of insurance coverage in the United States. You have commercial or private insurance, third-party administrators, Medicaid, vocational rehabilitation, Tricare, Veteran’s Administration, and worker’s compensation. Now I’m gonna provide a brief overview of each of these in this post, but I will be making separate more detailed posts about each, so make sure that you check out other posts on my YouTube channel. When it comes to commercial or private insurance, this is typically insurance that’s provided by an employer or by retiree benefits. Now when you’re thinking of how traditional insurance works, this is it. You will likely have a deductible that needs to be met and you may have some cost sharing or co-insurance and coverage limits before any portion of testing or hearing aids are covered.
Then the insurance company will pay for a portion of the remaining balance for the testing and the hearing aids up to a certain amount, in most cases. Many commercial or private insurance plans also have out of network benefits that you’ll find inside of PPO plans, but not HMO plans. This means that if you know a really good provider that you wan to go see, but they are not in network with your insurance plan, you can still go see that provider and you can still use your coverage benefits. When it comes to third-party administrators, otherwise known as TPAs or third-party networks, they basically act as a middleman between the insurance company and your hearing care provider to control costs for the insurance company.
There are typically no out of network benefits when it comes to third-party administrators. So if your hearing care provider is not inside of their network, then you will not be able to use your hearing aid benefits with them. These third-party administrators are owned by insurance companies and hearing aid manufacturers and they will control the type of products that you can get and the level of care that you receive along with the cost and the reimbursement to your hearing care provider.
Some providers like myself choose not to participate in third-party networks because the amount of reimbursement that we get from these networks does not cover the cost of doing business when you provide high-level care. Medicaid, not Medicare, but Medicaid programs are state-run and they typically provide hearing aid related services to individuals who are younger and sometimes adults as well.
The level of technology of hearing aids that you get from Medicaid is usually predetermined since the reimbursement rates are so low. Vocational rehabilitation, otherwise known as voc rehab, are state-run programs that typically provide assistance to individuals who are trying to stay in the workforce or trying to get into the workforce by providing them with some amount of hearing aid coverage.
Much like Medicaid, these programs typically provide a low level of hearing aid technology because again, the reimbursement rates are really low. Tricare is coverage for active duty military and may cover hearing aids and even bone-anchored hearing aids and hearing aid related services for service members and beneficiaries with a profound hearing loss. Tricare does not provide hearing aid coverage for retirees or their family members, nor does it provide coverage for reserve select members or retired reserve members. Then you have the Veteran’s Administration, otherwise known as the VA. Now inside of the VA, you have the VHA, which is the Veteran’s Health Administration, and the VBA, which is the Veteran’s Benefits Administration. Through the VHA is where you can actually get hearing aids usually at no cost to you and you get all of the care and services provided with that as well. And typically inside of a VA, they will only dispense the highest level of technology as well. And last but not least, you have worker’s compensation.
Now worker’s compensation is usually tied to a work-related injury, and there are usually no out of pocket expenses. But this really does depend on the type of plan that you have. Now it is important for you, if you have insurance, to understand what type of insurance that you have or what type of insurance you’re gonna be signing up for. As you can see, not all types of insurance plans are equal when it comes to hearing aid benefits. So you need to make sure that you’re doing your due diligence to find out exactly what type of coverage your insurance is gonna provide for your hearing aids.
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