Medicare Advantage Plan Hearing Benefits: Understanding Your Options

Many Medicare Advantage Prescription Drug (MAPD) plans include hearing benefits, but the way those benefits are structured can be confusing and limiting. This blog explains how third-party hearing vendor programs work, and what your options are.

How MAPD Hearing Benefits Are Structured

Most MAPD plans split their hearing coverage into two separate components:

• Audiology visits (exams, diagnostics, medical care), covered under the plan's standard specialist benefit, with a co-pay to see any in-network audiologist at a clinic or hospital.

• Hearing aid purchases, routed through a designated third-party hearing vendor program, separate from the plan's general network.

Common Third-Party Hearing Vendors Used by MN MAPD Plans:

Vendor	Commonly Used By
Nation's Hearing	Allina Health Aetna
TruHearing	BlueCross BlueShield, HealthPartners
UnitedHealth Hearing	UnitedHealthcare plans
EPIC Hearing	Medica

The Core Issue: Exam and Hearing Aid Purchases Are Bundled

Even though your plan allows you to see an in-network audiologist at your preferred clinic for an exam, your audiologist typically cannot write a transferable prescription to purchase hearing aids through the plan's vendor program. This happens because third-party hearing vendors generally require the hearing evaluation used for fitting to be performed within their own network of providers, the fitting and follow-up care to be handled by their affiliated providers and the entire aid purchase process; from exam to dispensing; to remain within their ecosystem.

If the Vendor Program Does Not Meet Your Needs

Option 1: Use the Vendor for Aids, Your Clinic for Medical Care

You may find you are satisfied with the hearing aids available through your plan's vendor network, but prefer to use your own audiologist for your exams. You can see your provider for medical conditions of the ear, including ear health, balance issues, tinnitus, and more, regardless of your plan's hearing aid network. You can also see your audiologist for diagnostic exams.

However, your audiologist visit will usually not substitute for the vendor's required evaluation for hearing aid fitting. If you want to purchase aids through the plan's benefit, you will likely still need a separate exam at a vendor location. You may end up having two exams; one with your own audiologist for medical care, and one with the vendor for the fitting.

Option 2: Purchase Hearing Aids Outside the Plan

You may find, however, that you are not satisfied with the hearing aid options available through your plan's hearing aid provider network. In that case, you may find you will need to purchase hearing aids independently, outside your plan's vendor program. Your plan benefit will not apply, but in some cases the pricing difference is smaller than expected.

Alternatives worth comparing:

• Costco Hearing Aid Center (licensed audiologists, competitive pricing)

• Direct-to-consumer OTC hearing aids (for mild to moderate loss only, per FDA)

• Independent audiologists who offer financing or sliding-scale pricing

Option 3: Shop Plans at Next Enrollment

If hearing aid access is a priority, consider plan options at the next Annual Enrollment Period (October 15 – December 7). When comparing plans, consider:

• Which third-party hearing vendor does this plan use?

• Can I see my preferred audiologist for the hearing aid exam?

• What is the dollar allowance per ear, or per pair, and how often?

Unfortunately, a common frustration is that the hearing aid facilities used by different carriers overlap significantly. In many cases, the same clinic or provider group is contracted with most or all of the vendors. This means if you switch carriers during AEP hoping for better hearing aid access, you may end up at the same location under a different vendor name.

The Bottom Line

Your coverage to see an audiologist and your hearing aid benefit are different components of your Medicare Advantage plan's coverage, and understanding them as separate benefits can be helpful. But you risk losing your hearing aid benefit if you don't use your plan's hearing aid vendor network, and your audiograms are usually not transferable. For these reasons, it's usually best to start by selecting an audiologist on-site at the same facility where you will get your hearing aids, within the plan's hearing aid network. However, if you are dissatisfied with your medical care, or with the hearing aid options available to you, you may need to investigate the other options available to you.

For assistance in understanding your plan's hearing aid benefit, or to discuss the options available to you, contact us today.