Most common audiology procedures are covered, especially by commercial insurance. Coverage is specific to each health plan policy holder. When scheduling an appointment, you should always be advised on the estimated cost of your visit. Don’t be surprised to find out that you will be paying out of pocket for some services.
COMMERCIAL INSURANCE
Commercial insurance is typically supplied by your employer or purchased through the insurance marketplace. Commercial insurance may cover most of your assessment for hearing, tinnitus, and balance services. Coverage of hearing aids and related services is specific to the insurer and the health plan. Benefits vary greatly plan to plan. Many insurers in Illinois will offer a plan option with hearing aid coverage. Insurance rarely covers the cost of custom ear protection, assistive listening devices, and aural rehabilitation.
MEDICARE AND SUPPLEMENTAL (MEDI-GAP) INSURANCE
Traditional Medicare will pay for your initial hearing evaluation and follow-up evaluations when there is medical necessity for the hearing assessment. Examples of medical necessity include concerns with balance, dizziness, sudden onset hearing loss, or sudden onset tinnitus. Traditional Medicare provides no coverage for hearing aids or any hearing aid related services, cerumen removal, auditory or tinnitus rehabilitation, or treatment.
The primary goal of a Medicare supplement is to cover Medicare co-insurance. As a result, most supplemental insurers will follow Medicare’s rules. When Medicare excludes coverage, the secondary will follow suit. Your supplemental insurance may offer benefits through a discounted program that requires out of pocket expenses. You may be restricted to see an in-network provider to access the “discount” benefits. Your coverage will come with limitations as to the number of services provided and products selected. If your product choices are limited, and you are paying out of pocket, you can always choose to see a provider of choice for a better option at the same cost.
MEDICARE ADVANTAGE
Advantage plans will cover most common audiology procedures. Check to see if there are other hearing benefits written into your policy. To access these benefits, you may be required to see an in-network provider.
MEDICAID
Medicaid restricts care solely to in- network providers.
EAR CLEANING
A physician can provide cerumen removal and bill for these services, but you will be subject to the procedure costs as well as co- payments, co- insurance, and any unmet deductible. An Audiologist can also provide ear cleanings. You may be required to pay out of pocket for these services.
Our Audiology home, The Academy of Doctors of Audiology, has been tirelessly working on your behalf to improve access to insurance benefits. We hope to have updates to share with you in the future.
It’s always prudent to review your specific policy. Benefits may vary for in and out of network providers. Let us know how we can help.