Funding for Hearing Aids

Tom McDonough, DATI Funding and Policy Specialist

There are approximately 28 million people in the United States who have a hearing loss that results in communication problems. This statistic represents approximately 10% of the population, which in Delaware means more than 80,000 people.

Hearing loss is not necessarily a natural consequence of aging. It is instead a health issue which can, if not treated, negatively affect a person’s physical and psychological well-being as well as their employment and community participation. Approximately 60% of people with hearing loss are between 21 and 65 years of age, and nearly three-quarters of those persons report that that their hearing loss was caused by something other than aging. These may include genetic factors, noise or trauma, viral or bacterial infections, and reaction to medications. Unfortunately, on average, people with hearing loss wait seven years before seeking help.

Although hearing aids can be immensely helpful, a surprisingly large proportion (75%) of people who might benefit from them don’t use them. When asked why, people typically cite three reasons: (1) a belief that the hearing loss is not severe enough to require a hearing aid; (2) stigma, particularly in the workplace where employees may be afraid that hearing aid use would make them appear less competent; and (3) the cost of hearing aids. This article focuses on the cost issue.

Hearing aids run from approximately $800 for an analog aid to approximately $2000 for a digital programmable aid. Considering that many users need two hearing aids, it is understandable that some people simply cannot afford to purchase them on their own. In fact, it has been estimated that approximately 7 million people who could benefit from hearing aids cannot afford to buy them.

In order to get hearing aids funded through insurance, they must be justified as a medical necessity. Despite the medical basis for hearing loss, however, Medicare does not pay for hearing aids. On the other hand, Delaware Medicaid will pay for hearing aids under certain conditions. For example, hearing aids for persons under the age of 21 are covered through Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Section 5.17 of Medicaid’s Provider Policy Manual provides that such requests must be supported by:

• physician’s “letter of medical necessity” with a complete medical diagnosis and supporting documentation;
• a copy of an audiologist’s evaluation;
• a speech/language evaluation or progress reports;
• discussion of trial assessment, including hearing testing;
• explanation of why the particular hearing aid was selected rather than other models;
• a full description of the hearing aid, including make and model number;
• an itemized explanation of all charges; and
• a copy of the vendor’s invoice for the hearing aid.

The amount Medicaid covers depends upon the actual cost of the hearing aid to the provider, plus a dispensing fee of no more than $400. Once the warranty expires, Medicaid will also pay for repairs up to 75% of the cost of a replacement device.

Although there is a widespread perception that Delaware’s Medicaid program will not pay for hearing aids for persons over the age of 21, the Medicaid official who reviews such requests recently informed DATI that Medicaid does not have a blanket prohibition against funding hearing aids for adults. Rather, requests should follow the procedure described in the bullets above; Medicaid will consider these requests on a case-by-case basis. These practices are shared by the Diamond State Partners, one of Medicaid’s managed care organizations (MCOs).

The news is even better when it comes to hearing aid coverage for those beneficiaries who subscribe to the First State Health Plan, Delaware Medicaid’s other managed care organization. First State’s definition of “durable medical equipment” (DME) includes hearing aids, and requests should follow First State’s general DME procedure.

For those persons who have Tricare (formerly CHAMPUS) military health insurance, hearing aids are covered if the person has a “profound hearing loss” as defined by the Department of Defense.

When it comes to private insurance, the picture is not so clear cut. Many plans offered by private insurance companies do not cover hearing aids; however, since there are exceptions, one should investigate carefully before selecting a particular plan. For example, both General Motors and Chrysler employees can get a single hearing aid every two years through the United Auto Workers insurance plan.

The State Division of Vocational Rehabilitation (DVR) and its Independent Living (IL) unit may be valuable funding resources for some persons seeking hearing aids. Initially, one must meet DVR or IL’s general elibility criteria, and the hearing loss must be severe enough to interfere with communication. In the case of IL, the client must also be “significantly disabled” in order to be considered for hearing aids. Once these requirements are satisfied, DVR/IL have specific procedures that must be followed (such as medical and audiological examinations), similar to those discussed above for Medicaid. Call the Delaware Helpline at (800) 464-4357 for the phone number of the DVR office closest to you and call IL at (302) 378-5779 for more information.

Older Delawareans (aged 65 and over) may be able to get hearing aids funded by the Nemours Health Clinic. Nemours requires that the person be a Delaware resident and U.S. citizen, and that their income be under $12,500 if single and under $17,125 if married. Nemours has clinics in Wilmington and Milford and their number is (302) 651-4405.

Other local options may include service organizations, such as the Lions Club. Most towns have a chapter of the Lions Club and some, but not all, of the chapters may help with funding for hearing aids. Those interested should contact the chapter in their area. The local chapter of the Self Help for Hard of Hearing People (SHHH) recycles donated hearing aids with the assistance of a local audiologist. Those interested in obtaining or donating hearing aids should contact SHHH at (302) 656-4882 or (888) 280-3330 (toll free).

Finally, if your efforts to find funding in Delaware are not successful, you may want to consider Hear Now. This is a national non-profit agency that provides hearing aids to low-income persons with revenue generated from the sale of used hearing aids to a manufacturer. Applications, which include supporting information from a health care provider, must be accompanied by a $30.00 non-refundable fee. If interested, contact Hear Now at (800) 648-4327.

References

Delaware Population Consortium. (2002). Annual population projections. Dover, DE: Author

Incidence and Prevalence of Hearing Loss and Hearing Aid Use in the United States. (2002). Rockville, MD: American Speech-Language Hearing Association. Retrieved February 21, 2003, from the the World Wide Web: http://www.professional.asha.org/resources/factsheets/hearing.cfm

Take Care Of Your Ears. They Connect You To The World. (n.d.) Bethesda, MD: Self Help for Hard of Hearing People

Insurance Coverage of Hearing Aids. (n.d.) Bethesda, MD: Self Help for Hard of Hearing People. Retrieved February 19, 2003, from the World Wide Web: http://www.shhh.org

Coming soon: Information on legislation requiring health insurers to cover hearing aids