Original Medicare is a health insurance program seniors in the United States can use to cover most of their hospital inpatient and outpatient medical needs. These benefits are provided under the titles Part A and Part B, respectively. Medicare Advantage, also known as Part C, combines these two benefits into a single plan, often with a low monthly premium. All authorized Medicare Advantage plans in the United States provide full Parts A and B coverage, but many offer extra options many seniors need that Original Medicare doesn’t pay for, such as eye exams and hearing coverage.
The extra coverage Medicare Advantage offers seniors who need hearing aids, hearing tests, and other hearing coverage makes this a very attractive option for beneficiaries on a fixed budget. The purpose of this guide is to help seniors and their loved ones understand the kind of hearing coverage Medicare Advantage offers, what the limitations and exclusions are, and how to access those benefits as part of a comprehensive Part C Medicare coverage plan.
Medicare Advantage plans are health insurance policies that are issued by private insurers who have been authorized to bill the Social Security Administration for approved group policies. These plans have to meet Medicare minimum standards for care and coverage, and some states impose standards for how plans can be written and what the allowable premiums are. Medicare Advantage plans invoice the Social Security Administration for many of their expenses, which allows them to charge what are sometimes very low monthly premiums for care.
Because many Medicare Advantage plans are partly billed to the federal government, they can offer steep discounts to program participants. Many Medicare Advantage plans, for instance, have monthly premiums as low as $0, albeit with a relatively high deductible. Other plans range as high as $200 a month for coverage, though these tend to be low-deductible/high-coverage plans. Three states: Massachusetts, Minnesota, and Wisconsin, not only require insurance companies to offer at least one Medicare Advantage plan, but also require insurers to offer low group rates that cannot refuse coverage for pre-existing conditions to any otherwise qualified applicant. Plans offered in other states must offer these rates and terms only to beneficiaries who apply during open enrollment, while more common underwriting rules apply for enrollees who sign up at other times.
Hearing exams and hearing aids can cost between a few hundred and several thousand dollars. These services are not covered by Original Medicare, though some Medicare Advantage plans do provide limited or comprehensive coverage for hearing care. The details of plan coverage vary significantly on a state-by-state basis, and even within states many individual insurers have different offerings with various levels of care. The Hearing Loss Association of America website has information on coverage options indexed by state, which can help seniors with Medicare Advantage find a local plan that provides hearing coverage.
If your Medicare Advantage plan is organized as an HMO, you may be required to buy your hearing aids through a network provider. If it’s a PPO, you may be able to go outside of the network, though the total cost can wind up costing more than an in-network hearing aid likely would. If your Medicare Advantage plan does not provide any kind of hearing coverage, or if such coverage is not available or affordable in your state, you may be able to buy the equipment you need out of pocket through any provider you wish.
Getting adequate hearing coverage through a Medicare Advantage plan may take some time and research. If you are looking for a plan with the coverage you need, you have several options for finding it. One option is to talk to a local insurance agent who can find a Medicare Advantage plan with all of the features you need free of charge. Another approach is to look through plan comparisons listed on your state’s healthcare exchange website, where plan features and prices are relatively easy to see side by side. You can also look through individual insurer’s websites to get comprehensive lists of features offered by that provider.
To qualify for a Medicare Advantage plan, you must be either a U.S. citizen or a permanent legal resident with at least five years’ residency in the country. In addition, you must either be 65 or over, or have been receiving SSDI for a diagnosed disability for at least 24 continuous months. To qualify for Original Medicare Part A with no monthly premium, you must also have at least 10 years, or 40 quarters, of payroll contributions to Social Security.
You can apply for either Original Medicare or Medicare Advantage when you first become eligible for the program, which starts with an open enrollment period that begins on the first day of the third month prior to your 65th birthday. In other words, if your birthday is August 10, your first open enrollment period begins on May 1, and it ends on November 30. During this time, you can choose any Medicare Advantage plan you like, and the insurer is required by law to offer the lowest group rate possible without regard to any pre-existing conditions you may have. If you enroll outside of the open enrollment period, you may be charged a penalty rate for joining late, or you could be denied coverage for a pre-existing condition. After your first enrollment, Medicare opens another enrollment period every fall on October 15, which runs until December 7. Also, you may qualify for a personal special enrollment period under certain circumstances. You can apply for a Medicare Advantage plan under special enrollment if:
Some Medicare Advantage plans offer comprehensive hearing coverage, while others do not. Some plans offer some coverage, with high or low premiums and a high or low deductible. Coverage varies with the state you live in, the insurance company you’re looking into, and the specifics of the plan you apply for. Ask an insurance agent about specific details of your potential plan before you commit to an option.
No. Beneficiaries who receive Medicare Advantage are not eligible for Medigap plans, which are intended as supplements for Original Medicare.
You may be able to get hearing coverage through a private insurance company, if you opt for a private plan. You may also be able to buy the hearing aids and other equipment you need by paying out of pocket, though this can be difficult for seniors with limited income. Some Medicare supplements, such as Medicaid, offer some hearing coverage, though the details vary by plan.
Some seniors use Medicaid as a supplement for their Medicare plans, though options vary by state and by plan. Seniors with Medicare Advantage who meet income and asset limitations may be able to use Medicaid for supplemental hearing coverage.
Medicare advisers are available for seniors who need help understanding their benefits. You can meet with a Medicare case worker at your local Social Security office, or you can call 1-800-MEDICARE (1-800-633-4227) to speak with a representative.