Many specialist patient needs, such as dentistry, vision and hearing, are now outsourced to managed care administration companies that have contracted with the major insurance company.
Managing health insurance benefits is not a new concept. A managed care company is a third-party company that the insurance company uses to help patients with specific benefits to keep their (the insurance company’s) costs as low as possible.
Managed care in the hearing aid market has become a huge factor in just ten years. When I started my business ten years ago, almost no one had hearing aid benefits under their major medical policies, and no one had benefits through Medicare supplemental coverage.
Today, 65% of all health insurance policyholders have some hearing aid benefit, and 45% of health insurance plans also offer hearing aid benefits. As insurance companies have been affected by the increasing demand for hearing aid coverage, primarily by baby boomers entering the hard of hearing age bracket, managing these benefits has become the industry standard.
This means that if your insurance company uses managed care, you cannot go out of the network and use a distributor who is not in that network.
It also means that the managed care group will guide you to their distributor, define product options and, most importantly, hearing aid prices. The audioprosthetist then becomes a “service charge” participating in the process.
The managed care model quickly gained favor with insurance companies due to the reality of very high prices. Currently, there are very generous insurance plans for hearing aids in our area. Insurance companies change these benefits from year to year, so the purpose of this article is to tell you to check your benefits now as they may be lower in 2023.
Many of the major insurance plans in our area offer great benefits for hearing aids. Some with zero co-pays and many with very reasonable co-pays. I am a provider for most insurance plans, but there are other providers in the area. Call the customer service number on the back of your insurance card to find out what benefits you may be entitled to.
Some insurance companies are planning to change their coverage next year, so now is a great time to check and find out about your benefits. Most of the benefit coverage for hearing aids is found in Medicare.
Supplemental Plans Advantage: Many of these plans are zero premium plans, so you should check with your insurance broker to find out which plan offers the best coverage.
By the way, beware of celebrity-endorsed ads offering a long list of free Medicare supplement benefits. Those 800 numbers simply forward you to out-of-town brokers who will prospect you for what’s best for them, not you.
Use local insurance professionals. Especially if you expect customer service with your plan choices. Some people are reluctant to leave their current diet because they are satisfied with the “doctor” or the medical aspect of the coverage.
This is an important factor to consider when discussing the benefits of hearing aids with your agent.
If you’re still working, talk to your human resources staff at work about what coverage, if any, you might have for hearing aids. Better hearing is always a “sound” investment as my ads here in L’Express say, but better hearing also has a price.
It would be very wise to check your insurance now and be prepared to speak with your insurance agents during the upcoming Medicare enrollment season this fall.
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Jeffrey L. Bayliff owns the Hear the Birds Hearing Aid Center in Lock Haven.