Recently, in the Kansas City area market we have seen an increase in the number of patients who are enrolling in Medicare Advantage (Medicare replacement) plans. Unfortunately, many individuals do not understand how their plans work, especially as it relates to hearing aids. Here is some information from the Medicare.gov website that helps further explain these plans.
Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are an “all in one” alternative to original Medicare. They are offered by private insurance companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. These “bundled” plans include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), and usually Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care each month to companies offering Medicare Advantage plans. These companies must follow rules set by Medicare. Each Medicare Advantage plan can charge different out-of-pocket costs. Please be aware that even if you subscribe to a plan that says it charges zero premiums, YOU still have to pay your monthly Medicare premiums.
What Does This Mean?
That means the insurance company you purchase this plan from receives a monthly amount to take you on as a patient. This is paid by Medicare. PLUS, you have to pay them your Medicare premiums, instead of paying them to Medicare. Depending on how your plan is structured, you may not have to pay any additional premiums (where the zero premium claim comes in). Or, you may have additional premiums on top of your Medicare premiums.
Medicare Advantage plans can also have different rules for how you access services, like whether you need a referral to see a specialist. Or, they may require you to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care. These rules are subject to change each year.
Medicare Advantage plans cover all Medicare services. Some plans also offer extra coverage, like vision, hearing and dental coverage. This is where things can get complicated regarding hearing aids.
Traditional Medicare DOES NOT cover the cost of hearing aids, and even though some Medicare Advantage plans claim to offer a hearing aid benefit, you should be fully educated about how this works.
“After working with several of these plans, we have found that sometimes the hearing aid benefit covers only a low-end hearing aid that may be less sophisticated than some of the older hearing aid technology our patients are already wearing, or is not appropriate for the type of hearing loss they have,” explained Tim Steele, PhD, President and CEO, Associated Audiologists.
“In other cases, the plans are so restrictive in terms of providers or treatment choices, the hearing aid coverage turns out to be of little benefit at all.”
For patients who have purchased these plans thinking they now have coverage, not only for hearing aids, but other services, like dental or vision, this can be very frustrating.
“Before you sign up for an advantage plan, check the benefits very carefully as they relate to all your health-related services,” Dr. Steele said. “For hearing aids, call our offices and we will check the benefits to see if they would be helpful for you. In some cases, these are mail order devices and in others, they have very few providers enrolled to provide coverage causing confusion and delays for beneficiaries who want to utilize their benefit.”
If you signed up for an advantage plan and want to switch back to traditional Medicare, you can do so during the next open enrollment period.
“Ultimately, many patients have been confused by the ‘zero premium’ claim these companies make,” Dr. Steele said. “You still have to pay your traditional Medicare premiums, plus you may have to pay an additional plan premium. This is definitely a case of ‘there’s no such thing as a free lunch. And you should fully understand the hearing aid benefits these plans offer so you aren’t surprised. To avoid disappointment and frustration, check with us to see what’s covered before signing up.”
How to File a Consumer Complaint
Increasingly, patients believe they have insurance benefits that cover the cost of hearing aids, only to have the claim denied. If you believe a claim has been wrongly denied, you can file a claim complaint. You can also file an insurance complaint regarding any health matter that you believe was unjustly denied or confusing from your health insurance provider.
The Insurance Commissioner’s Consumer Assistance Division assists Kansas insurance consumers. To file a consumer complaint against an insurance company/agent/agency, visit https://www.ksinsurance.org/department/complaint.php and you will be taken to the Kansas online complaint form.
Under Missouri law, you have the right to appeal the insurance company’s decision to deny your treatment. This is an opportunity for you or your provider to give additional information to your insurance company or clear up any miscommunications about your treatment.