More and more Medicare Advantage health plans are including a benefit for hearing aids. If you are thinking of switching from a traditional Medicare health plan to a commercially available Medicare Advantage health plan for the purpose of getting a benefit for hearing aids, there are some things you should know. If you are unsure what Medicare Advantage is, you can learn more by clicking here.
Healthcare providers have long been required to be “in network” or approved by individual health insurance companies in order to be able to see members of health plans and be paid for the services provided. Enrolling as participating is a process that providers must complete with each health insurance company.
Traditional Medicare has never covered hearing aids. Medicare Advantage plans such as Humana Gold, Anthem Mediblue and United Health Care plans have added benefits for vision, dental and hearing aids in order to make their plans more attractive. However, at least for hearing aids, this is not a traditional or direct benefit. This means that a provider who is in network with the health plan is not automatically able to provide hearing aids and related services and expect to be able to be paid for the services. Health insurance companies have, by and large, entered into contractual agreements with third party administrators. It is the third party administrator that fulfills the benefit for hearing aids.
Third Party Administrators
Third party administrators are just what the name suggests. Traditional coverage of medical services is an interaction between the provider and the health insurance company. A third party is a separate entity that is inserted into the process between the provider and the health insurance company. When it comes to hearing aids third parties are basically large companies that have been in the business of selling hearing aids to the public through the internet. Since best practices dictate that hearing aids must be fit in an in-person session with a professional trained to provide such services, the third party administrator hires local providers to provide this part of the service. This results in a situation where the member is obtaining the hearing aid from the third party and the third party, not the insurance company, pays the local provider a fee for their services. Because third parties are national companies serving many if not all states, they are able to buy hearing aids in bulk from the manufacturers which leads to lower prices and savings to the health insurance company.
Third parties have their own network of approved providers and their own way of approving providers to be in that network. It is completely separate from the network of the health insurance company, so it is entirely possible that a provider is in network with the health insurance company, but not in network with the third party. This can be confusing because customer representatives at health insurance companies are not always able to be crystal clear with members about how this benefit works.
There are three third party administrators that are under contract with health insurance companies to provide the hearing aid benefits to health plans in Missouri. The chart below shows each of these third parties and the health insurance companies with whom they are contracted. Members of Anthem and Aetna Medicare Advantage plans will be able to obtain hearing aids through Hearing Care Solutions. Members of Humana Medicare Advantage plans will obtain hearing aids from TruHearing. Members of United Health Care Medicare Advantage plans will obtain hearing aids from United Health Hearing (formerly known as Epic Hearing).
Using Your MediCare Advantage Hearing Aid Benefit
Your policy documents should provide you with a phone number to call in order to get access to the correct third party administrator for your hearing aid benefit. However, it can be the case that the information is not clear in those documents. Another option is to use the table below to find the third party that works with your insurance company and contact them directly.
If you have a plan from a company not listed, call the number on the back of your health insurance card. Ask the representative about your hearing aid benefit. After the information is provided ask them to be very clear about where you need to go in order to get hearing aids. Ask them to double check that information.
Another way to learn about how a hearing aid benefit works with a third party administrator is to look through the materials that were mailed to you when you first enrolled in the program. These documents are called Summary of Benefits and/or Evidence of Coverage. If you no longer have these documents or if you are thinking about switching to a Medicare Advantage plan you can see these documents in the websites of health insurance companies. To find them, go to the website of the company you want to research like www.humana.com. Once you are on the website you will easily find a button that says, “Shop for Medicare Advantage Plans”. You will need to type in your zip code in order to find out what plans they offer in your area. Once you choose a plan to look at you will have to scroll through the document but keep looking and you will find blue links to the Summary of Benefits and Evidence of Coverage documents.
Or, call us at Hearing and Audiology Services and we will be happy to help you determine how your benefit works.
How can I find out if my Medicare Advantage plan covers hearing aids?
There are several ways. 1) Look through the materials mailed to you when you enrolled in the program. You should have documents called Summary of Benefits which describes everything that is covered. Hearing is usually towards the end of the document. It may tell you the name of the third party you will need to use. In Missouri the choices are Hearing Care Solutions, TruHearing or United Health Hearing.
2) Call the number on the back of your health insurance card. Ask the representative if you have a benefit for hearing aids. Once the benefit has been described ask the representative if you can go anywhere you want or if you have to go to a specific provider. Ask them that same question three different ways and push them to be very sure.
What is a third party administrator of hearing aids?
Typically, there are two “parties” involved in your health care: the health insurance company and the provider. The provider provides the service, files claim with insurance company and the insurance company pays the provider. For hearing aids, insurance companies have hired outside companies to provide hearing aids. The outside company is the third party. The third party provides the hearing aids. Since the third party is not a local company, the third party must hire local providers to deliver and fit the hearing aids. In this situation the health insurance company pays the third party and the third party pays the local provider – three parties involved instead of two.
How can I find out if the hearing aid benefit on my Medicare Advantage plans uses a third party?
This question is the same as “Where do I go to get my hearing aids?” or “can I go anywhere I want to get my hearing aids?” In theory, the information should be clearly stated on your health plan documents as well as from customer representatives at the health insurance company. However, this is not always the case. Use the table below to determine which third party is under contract with your health plan. These relationships may change from year to year, but the chart below is true for 2020 and 2021 for most plans available in Southwest Missouri.
If a provider is in network with my health plan does that mean I can get hearing aids from them?
Not necessarily. If your health plan has contracted with Hearing Care Solutions, Truhearing or United Health Hearing you will have to get your hearing aids from a provider who is in their network. This is a completely separate network that is maintained by the third party, not the insurance company. Warning: this is the information that customer service representatives at health insurance companies are not always able to be clear about.
How can I be sure that I have an appointment with a provider that is in the correct network?
Your health insurance company should give you a phone number to the third party: Hearing Care Solutions, TruHearing or United Health Hearing. When you call the phone number, they will ask you for your member ID number from the health insurance card and they will verify your benefit. Once the benefit is verified, they will schedule the appointment for you. In some cases, the third party will send a notification to the provider and the provider will contact you to schedule.
Do I have to go to the audiologist that the third party recommends?
Yes and no. You do have to go to a provider that is in their network. If there is only one in network then yes, you have to go to that one. If more than one audiologist is in their network, then you have a choice. But the choice is not always made clear. I recommend that you do your own research on audiologists in your area. Call local offices and ask if they are in network with your third party. Once you have determined who you would like your audiologist to be you can have that information ready when you call the third party to make the appointment.
Are all of the providers in network with the third party’s audiologists?
No. Most third parties allow both audiologists and hearing instrument specialists into their networks. I suggest that you know the difference and make an informed decision. Watch my blog page for information about the different providers that work with ears and hearing.