Medicare Advantage’s quiet revolution in Hearing Health

With hearing loss considered to be a social determinant of health, Medicare Advantage payers have taken a more comprehensive approach to hearing health over the last five years. Medicare Advantage (MA) enrollees electing plans this season—open enrollment has been in full swing since October 15—have significantly more options and richer benefits for hearing aid coverage, with copays in some cases as little as $100 for a hearing aid.

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I think this is having and will continue to have more of an impact on the market and hearing aid prices than OTC hearing aids. I see this as more being part of a buying group rather than as more traditional “insurance.” There will be real challenges to control cost since people who need hearing aids will tend to self select programs that offer hearing aid coverage. On the flip side, as plans have more customers, they may be able to bargain harder.

I also see here in the USA that hearing aid prices will go up for the ones that don’t have insurance to help them out. And there will always be that group of people. The other thing I see is that like everything else drugs coming to my thoughts first that the insurance companies will force generic aids on most that don’t really meet their total needs.

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Keep your eyes, if you can, on what the private ins. co.s selling the so-called “Advantage” version of Medicare take away while offering shiny objects like trivial coverage amounts on hearing, dental and optical, to-wit: restriction of health care to their “networks” where your chosen doctor can be in when you sign up and out the next year; lack of choice of the best specialists when critical illness strikes; rejection of recommended procedures which regular Medicare would have paid; annual and lifetime limits on benefits when critical illness strikes which do not exist in regular govt. issued Medicare.
Given the choice I’d rather continue to pay for my own hearing aids, eyeglasses and dental cleanings rather than be under the thumb of for-profit health insurance claims personnel trained to say “no!” where govt. medicare says yes, and the hospitals and doctors cannot balance-bill you as they can and do under “Advantage” policies.

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I agree that it’s important to know what you’re really getting into when you choose a health insurance program. I don’t think anybody’s allowed to impose lifetime limits anymore. I also wouldn’t paint with such a wide brush regarding “Advantage” plans. I’m quite pleased with my Kaiser Permanente Advantage plan (although it doesn’t cover hearing aids).

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Nate lists some factors to consider when selecting among Medicare and Advantage plans. But he erroneously implies that all Advantage plans fail the issues he lists. My Advantage plan is far superior to Medicare, and has none of the disadvantages he lists. It is the most expensive plan available in MA but has saved me many tens of thousands of dollars compared to Medicare’s coverage. It is the only Advantage plan in MA which Medicare has rated 5 stars five years in a row. Advantage plans vary among companies and among states, so due diligence is called for as Nate says, but don’t assume as Nate does that Advantage plans are all worse than Medicare. Decide for yourself.

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MDB and Doug:
I stand corrected. Thank you for your kindness in making your counter-points.
In addition, I inadvertently failed to make clear that I was comparing Advantage plans to the combination of Medicare+Medigap+Part D, not merely Medicare alone. I apologize. (Medigap pays Medicare’s annual and 20% deductible and Part D provides Rx coverage.)
I would be interested in studying any detailed comparisons between that combination vs Advantage, as you both have convinced me that it is unwise to overgeneralize.

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Probably a valid description of all medical insurance.

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The link you gave apparently has been removed from the MedCity News website.
I did find this:

I took out a Medicare advantage plan effective October 1st 2019.I already have new hearing aids through them. Came from Truhearing. Will keep as backups ,in case my Marvels need repairs. $0.00 copay. $RETAIL was $3200.00. I have no idea how much insurance paid. Sure it wasn’t retail. But they were free. Couldn’t believe it.

I think my view of medical insurance is hoping I don’t get sick or have a serious accident, but knowing I have insurance is reassuring and can prevent me from going bankrupt. There is shared risk. The insurance company knows some people will need expensive treatment, but because the risk is spread out, it works out ok.

Having a known hearing loss and buying hearing aid coverage is thinking that the “insurance” will get you a better deal than you could get on your own. In this situation there is no real shared risk. Likely everybody who bought hearing aid insurance plans on getting hearing aids. The only way for it to save people money is through getting a volume discount.

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Nate, I think it is difficult to make these comparisons because of the different plans by different companies in different state. I agree about the balance billing issue, but my Advantage plan guarantees that I will never have to pay more than $3000 of balance in a year so I have at least that in a separate savings account. I haven’t come anywhere near that amount despite having six modest surgeries in a year at a cost to my Advantage insurer of about $20,000 each, and my balance billing being less than $100 each. Anyway, I forwarded your comment to a friend who is joining Medicare this year and has to think about all those issues you raised, for which he and I thank you.

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fyi blue cross insurance use true hearing as a vendor - watch out - they sent me to an underqualified vendor, and they only allow 3 fitting visits, during which she didn’t know what she was doing.

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I had bought Phonak marvels from them in January. They sent me to Connect Hearing, She knows what She’s doing. Went last week to have the marvels updated. The ins. also pays for future visits with a 20% copay.

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Out here in Washington State, the Advantage programs will provide a $ discount, but it is still a lot cheaper to go to Costco, because the private audiologists jack up their prices accordingly.

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The original article is back up. I think they needed to take it down to make an edit …

Something else to consider . . .
From today’s New York Times:
“In your recent discussion of limitations of Medicare Advantage plans, you did not include information about improper claims denials and the difficulty people have pursuing appeals. That certainly should be part of your coverage.
A report last year by federal investigators did find that Advantage plans have a pattern of inappropriately denying patient claims. The Office of Inspector General at the Department of Health and Human Services found “widespread and persistent problems related to denials of care and payment in Medicare Advantage” plans. The report examined appeals filed by patients and health care providers from 2014 through 2016, and found that Advantage plans themselves overturned the denials in 75 percent of cases.
However, very few claim denials are appealed — just 1 percent during the three-year period reviewed in the inspector general’s report.
The Advantage payment model reimburses plans a preset amount per patient; that may be incentivizing plans “to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,” the report concluded.
“We see plenty of denials by Advantage plans that shouldn’t be denied, and wouldn’t be if the patient had been enrolled in original Medicare,” says David Lipschutz, associate director and senior policy attorney at the Center for Medicare Advocacy.
Among the most common problems, he says, are early hospital discharges, denial of care in a skilled nursing facility or home health care.”

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There are advantages and disadvantages to any insurance model. One of the big issues with the fee for service model that traditional Medicare uses is that it encourages too much “care.” Overtesting is rampant. I’m sure there are many reasons for it, but getting paid more if one does certainly doesn’t discourage it. Such a model encourages more PSA tests, more prostate biopsies, more heart testing, etc. Many people think “Good, they’re looking out for me,” but there are real downsides to overtesting. I encourage everybody to make their insurance purchasing decision carefully, but I wouldn’t rule out an Advantage plan (or a supplemental plan for that matter).

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Your point is well-taken, but there is a built-in disincentive for over-testing in govt. Medicare. It may exist in Advantage too. That is, that govt. Medicare has standard pre-requirements for prescribing testing based on age, prior health and symptoms. You can usually look these up on the internet. If those requirements are not met, the claim submitted by the medical provider is denied and both the provider and the patient receives a notice that they are not to be billed for the unpaid charge and are not to pay it if billed.
This provides a substantial disincentive to the doctor not to order unnecessary tests.
Ocasionally, I get notices of such denials of payment for tests, and I never hear any complaints from the doctor, whose attitude seems to be something along the lines of “If I think it is important and should be done I will order it. If they pay it that’s okay and if they don’t that’s okay too.”

For example: America’s Epidemic of Unnecessary Care | The New Yorker

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