Does Medicare Cover Hearing Aids in Illinois?

In Illinois, about 16% of all people suffer from mild to severe hearing loss (Illinois Deaf and Hard of Hearing Commission).

Hearing loss goes far beyond turning up the TV or asking people to speak up. Not being able to communicate well profoundly affects the brain and increases the risk of walking problems, depression, isolation, and dementia (John Hopkins Medicine).

The best way to stop these hearing loss-related brain changes from compounding is to get properly fitted with a hearing aid as early as possible.

The problem? Hearing aids can be expensive, often costing $5,000 or more for a high-quality, professionally fitted set.

People over the age of 65 are the most likely to suffer from disabling hearing loss, but does Medicare step in to help with hearing aid costs?

Hearing Aids and Medicare

Medicare does not cover hearing exams, hearing aids, or the fitting of hearing aids. If you have Medicare with or without a Medicare Supplement, you are responsible for 100% of the cost for hearing aids and exams.

That goes for all states, including Illinois.

If you have Medicare with or without a Medicare Supplement, you’ll have to pay for your hearing aids and exams entirely out-of-pocket. However, talk to your audiologist first about your options.

Especially if you’re going to private practice, many will work out a payment plan to make the cost of hearing again affordable.

What About House Bill 3503?

In the news, you may have seen a mention of House Bill 3503, which requires insurance companies to offer optional coverage for hearing aids, with a reimbursement benefit of up to $2,500. This law went into effect in the state of Illinois on January 1, 2020.

However, if you read the bill, it’s pretty limited.

The insurance company can charge a higher premium for including this benefit, and they can make the hearing aid benefit optional. In addition, the insurance company doesn’t have to provide the hearing aid coverage if they’re unable to “meet mandatory minimum participation requirements,” and the insurers set those requirements themselves.

We confirmed directly with the Centers for Medicare and Medicaid Services (CMS) that Medicare and Medicare Supplements are not affected by this bill and are not required to provide hearing aid coverage.

Hearing Aids and Medicare Advantage

Many Medicare Advantage plans offer extra benefits like dental, vision, and hearing coverage.

The exact hearing benefits with a Medicare Advantage plan will vary widely depending on the plan. We’ll provide two examples of Medicare Advantage plans in Macon County to show how different the hearing benefits can be.

Hearing Aid Coverage with Aetna PPO Example

In Macon County, one of the most competitive options for the 2021 plan year comes from Aetna.

The Aetna Medicare Value Advantra (PPO) offers $1,250 of hearing aid coverage per ear, and you can get two hearing aids every year. However, you must purchase the hearing aid through NationsHearing, or you will not receive any hearing aid coverage.

If you see an in-network provider, there is a $40 copay for each Medicare-covered hearing exam and a $0 copay for each non-Medicare covered hearing aid fitting/evaluation.

If you see an out-of-network provider, you pay a 35% coinsurance for the exam and fitting.

While you must get your hearing services through NationsHearing, there is still great value in the hearing coverage provided by this plan.

Hearing Aid Coverage with Humana Regional PPO Example

Another 2021 plan option in Macon County comes from Humana. The HumanaChoice Regional PPO offers some coverage for a hearing exam. With this Medicare Advantage plan, you’d pay a $50 copay for a hearing exam from an in-network provider.

If you saw an out-of-network provider, you’d pay a 50% coinsurance. For context, a hearing exam typically costs between $150-$200, so a realistic cost for seeing an out-of-network provider would be $75-$100.

This particular Humana plan does not offer any coverage for a fitting/evaluation or hearing aids.

As you can see, the hearing benefits provided with this plan are quite different from the Aetna example.

It pays to compare plans to ensure you get the benefits that are the most important to you. Our team of licensed sales agent can help you do this!

Hearing Aids and the Medicare Advantage MSA

A Medicare MSA, a type of Medicare Advantage plan, is a $0 premium, high-deductible health insurance plan paired with a unique deposit that you can use for qualified medical expenses.

The Medicare MSA is a lot like a Health Savings Account (HSA), but instead of you funding it, the insurance company does. You can use those funds for any Medicare-covered expenses in addition to any qualified medical expense.

Hearing aids, while not covered by Medicare, are considered a qualified medical expense, so you could use your MSA deposit to pay for them. While the expense would not count toward the deductible, you could still get significant help paying for your hearing aids and exams.

In 2021, there are two MSA plans available in Macon County, and both are from Lasso Healthcare. One plan comes with a $2,000 yearly deposit (and a $5,000 deductible), and the other comes with a $3,000 deposit (and an $8,000 deductible).

Depending on your chosen MSA plan, you could have up to $3,000 in funds to use toward hearing aids.

Hearing Aid Assistance for Low-Income

Many individuals over the age of 65 cannot afford the cost of hearing aids, despite needing them to communicate and avoid hearing loss-related issues like dementia.

The Hearing Loss Association of America has a list of resources for those who need financial assistance. Programs like Medicaid and the VA may be able to help.

Also, don’t forget to talk to your audiologist or hearing aid provider. They may have programs or payment plans to help.

Conclusion

Unfortunately, Medicare with or without a Medicare Supplement does not help cover any costs associated with hearing exams or hearing aids.

Some Medicare Advantage plans come with hearing benefits but check the Summary of Benefits before choosing a plan. The benefits vary widely from plan to plan.

Our team of licensed sales agents can help you compare plans with some basic information, including your name, zip code, and birthdate. Just give us a call to schedule an appointment!

You can also conveniently schedule your appointment online using our online scheduling system.