1. Get Hearing Aids covered by Insurance
An aging population, along with implementation of the Affordable Care Act’s essential health benefits provision, could soon shine a spotlight on the issue of hearing health care and hearing aid insurance, a benefit commonly left out of traditional commercial health plans and specifically excluded from Medicare.
According to the Hearing Loss Association of America, 20% of the U.S. adult population — 48 million people — is living with some form of hearing loss. But the National Institute on Deafness and Other Communication Disorders (NIDCD) reports that only one in five people who could benefit from a hearing aid actually wears one. Price is one major reason, as hearing aids typically run from $1,000 to $5,000. Add in the cost of hearing aid tune-ups and the fact that hearing aids generally last only three to five years, and the financial investment can quickly become unsustainable for those whose insurance plans don’t include them.
“The best thing you can say is that it’s kind of all over the board,” Janet McCarty, M.Ed., director of private health plan reimbursement for the American Speech-Language-Hearing Association (ASHA), tells HPW
on the issue of hearing care insurance in both the commercial and government setting. “It’s not cut like vision and dental.”
Pediatric coverage is a little more widespread, given the effect that hearing loss has on a child’s cognitive abilities. Currently, 20 states mandate insurance coverage of hearing aids for children, while only three of those states — Arkansas, New Hampshire and Rhode Island — extend some insurance requirements to adults. While McCarty tells HPW
“we pull out all the guns” when it comes to pediatric care, a recent survey of state and public employers conducted by ASHA found that 41% of respondents did not include coverage for children’s hearing aids, while only 18% did. (The remaining 41% did not specify.)
Even government assistance is fragmented. Medicaid coverage varies from state to state, with some state Medicaid regulations excluding hearing aids entirely. Lise Hamlin, director of public policy and state development for the Hearing Loss Association of America, says despite Medicaid program regulations, it can be tough to find a hearing aid dispenser who accepts Medicaid, citing “onerous” paperwork and a significant lag time in reimbursement.
While Medicare Advantage plans may include hearing aids, traditional Medicare, on the other hand, excludes hearing aids entirely, a surprising fact considering the prevalence of hearing loss among the elderly. “That’s a big question,” Hamlin says. “It makes no sense to most people. Most people are shocked when they find out. Even legislators are shocked.”
McCarty says while commercial plans are “shaking loose” from examples set by federal health options like Medicare, many still design their products along similar lines. “We don’t know how much of that impacts the private health plan coverage,” she says. “We do know that a lot of private plans take their cues from Medicare, and so if Medicare doesn’t cover hearing aids, ‘OK, we’re not going to cover hearing aids.’”
Hamlin says some audiologists are also averse to working with insurers because of the additional paperwork and potential payment caps. But both McCarty and Hamlin see potential for coverage expansion under the ACA’s 10 essential health benefits (EHB), the minimum benefits that non-grandfathered plans in the individual and small-group markets must include, although little has changed thus far.
The seventh EHB is “rehabilitative and habilitative services and medical devices,” which hearing care advocates interpret to include hearing aids. But the interpretations of EHBs vary significantly from state to state, and the standard for interpretation is set by the state’s benchmark plan. If the benchmark plan doesn’t include hearing aids as an essential medical device, then other plans are under no obligation to insure them either. Benchmark plans are also not necessarily permanent, as they’re currently only green-lit for 2014 and 2015. CMS said it plans to revisit the benchmark policy for plans starting in 2016.
Hearing aid users do have some options currently available to them. The Department of Veterans Affairs ensures hearing aid coverage, and the Federal Employee Benefit Health Program includes a hearing aid option as well. In some states, like Texas, working adults can qualify for hearing aid coverage. A few private hearing health plans, such as EPIC Hearing Healthcare, have also begun popping up to offer hearing benefits to employers and larger insurance companies in the same fashion as vision and dental.
EPIC is a Pomona, Calif.-based hearing plan that launched in 1997 after its president, Brad Volkmer, hatched the idea with an investor, who also happened to be a patient of the hearing clinic he worked at in Los Angeles. Dru Coleman, EPIC’s national sales and marketing manager, said membership has grown “exponentially” since its inception — 20% alone in the last year. EPIC’s offerings include a full range of coverage options: fully insured, administrative services only (ASO), value-add and workers’ compensation.
The low cost of the benefits is also similar to dental and vision. A fully insured hearing exam benefit through EPIC costs employers only around 35 cents per employee per month, and a benefit that includes both hearing exams and devices can cost as little as $2 per employee per month. EPIC also offers hearing aids at a 30% to 60% discount from the retail price.
Insurer giant UnitedHealth Group extended its hearing coverage in 2011 with the initiation of hi HealthInnovations, a hearing health plan that offers similar services and discounts to EPIC. United launched the subsidiary after a survey found affordable hearing aids were one of the top three things consumers wanted most, behind affordable health insurance and prescription drugs.
hi HealthInnovations CEO Lisa Tseng, M.D., says the company offers two “bucket” options: a discount program, where hearing aids are sold anywhere from $799 to $999, and a benefit program. While Tseng declined to give specific numbers, she says hi HealthInnovations has expanded rapidly since its start. Health plans are feeling increasingly “commoditized” in the new landscape, Tseng says, and she predicts hearing insurance will continue to grow.
2. UK Socialized Medicine Now Rationing Hearing Aids