Question - Insurance Coverage/Medicare for CI

From what I can gather the only (full) coverage for a CI is through Medicare. Uncle Sam will pay for the full cost of one CI but most likely not for a second. But lets say in the next two to five years medical science replaces the CI with something better, that improves one’s hearing yet doesn’t require the Cochlear nerve connection between the ear and brain to be severed. If such a device should be become available to the masses over the next five years would Medicare pick up the total cost for surgery/usage versus what they currently pay/cover for a CI?

Now I understand at some the FDA or some federal agency has to bless off a possible CI replacement or alternate option, but would Medicare coverage be automatic once that happened? It should be. Seems to me if there are thousands of patients on Medicare coverage who want the next best thing to replace or improve a current CI, the government should allow complete 100% cost coverage for such medical devices immediately as soon as such new devices have been determined to be safe and improve a user’s hearing level. Not looking for the Chicken before the egg, but also don’t want Medicare to delay in covering medical cost or new device cost when and if a significant improvement over current Cochlear Implants should b e found.

Anyone have a feel how fast Medicare would react if we get some medical breakthrough to replace current CI in the future?

I always feel the best position is to assume that any insurance, medicare or otherwise, will make every attempt to pay for as little as humanly possible. Remember, insurance coverage is a business…medicare although not a private company - isn’t going to go paying for every newfangled thing out there simply because it’s the “best”.

All this is moot anyway because there is not much chance of something coming along in the next 5 years that is leaps and bounds beyond a CI for people who have no functional hearing with hearing aids.

Where is Medicare going to get the money to cover thousands of people getting the latest cutting-edge treatment? They’re having a hard enough time covering basic things; even if it’s a worthy goal it’s just not realistic. It takes a while for things to be approved, so I wouldn’t hold my breath.

Where does Medicare get the money? The agency gets the money by replacing the cost of an out-dated Cochlear implant (which the govt. currently pays for - surgery included) and uses that money towards the next advancement in hearing improvement for the benefit of user and society in general. CI will not be around in ten years, much less five years. Its been around now for 31 years and millions are now being spent in R&D dollars to replace it or improve it. Two things you are forgetting. Baby boomers are all now entering retirement age and with that a huge segment of the population will need hearing assistance at all levels. CI levels too. Secondly if Medicare has already approved covering the cost of a CI, then the money is already their (approved) for future use on hard of hearing seniors. the deaf community, sudden hearing loss, people with severe to profound hearing loss, etc. Medicare will cover the cost for new device(s) that replace the CI if the (replacement) is a significant improvement to user and safe to use. So if Medicare currently pays out $70,000 to $95,000 for a CI, the agency is forced to use the same amount of dollar coverage for a new or improved CI that medical science says replaces old CI technology. And lets not rule out that what ever replaces the CI might actually be cheaper then the the current CI price tag. Less surgery, less time in hospital less recovery time, etc., all means less dollars spent, not to mention any device to replace a CI will also probably cost less. You think Medicare won’t be willing to pay say $50,000 for a CI replacement, then the current price tag of $95,000 for existing CI?

Oh and in five years or say around 2018 - 2019 the CI could be a thing of the past, so don’t keep looking in your rear view mirror.

Not looking in the rear view mirror, just not depending on the government to provide anything but the basics in the future. The current Medicare budget will only go so far, and there are fewer workers coming up to pay for things.

anyone know if there is an upper age limit on cochlear implants?

I live in fear that I will go deaf in my left ear (right ear already dead) and would feel better if I could get a CI

From what I’ve read there is no upper age limit to implanting CI’s. I personally know a couple of people in their 70’s who got CI’s. Other than obvious health issues that would preclude someone who is old from having the surgery, their criteria is the same as the rest of the population.

There is no upper age limit. The oldest implant user for Cochlear America was 104 at time of surgery. It all depends upon the health of the individual.

I agree with that…in fact there was no upper age limit for that.

I know this post is almost a year old, but Medicare only covers 80% of CI costs (surgery/device, follow up audiology visits for MAPpings, new batteries/replacements of headpiece/mics/whatever that’s necessary for the processor to function, not random “fun” accessories like color covers). If you have secondary insurance, they may cover the remaining 20%. Upgrading to a new CI processor after 5 years if a newer processor exists, again still 80% coverage.

Medicare Advantage plans cover up to 100% of the costs, depending on the particular plan you have. My total out of pocket was $25. I don’t think they pay for replacement of accessories when ever they are needed however such as a remote control.

I know with Advanced Bionics, Medicare will pay for cables, batteries, and replacement T-mics (for me I still have the 20% copay with Medicare cover 80% with no help from Medicaid as AB doesn’t have a contract with the state Medicaid). FM’s, remotes and the like, not likely. Most definitely not color caps and fun stuff.

Unless you haven’t noticed, the ACA gives a panel of appointed Washington Bureaucrats the sole power to decide what medical procedures will be covered, and for whom. Since a large majority of HOH people are in the over 65 age group, it is evident that those same bureaucrats will be very tempted to reach the conclusion that the money necessary to perform advanced treatments on that old-age group would be better spent on some other “Government Necessity”. In other words, I wouldn’t hold my breath waiting on this to happen! If Granny’s too old, you can forget them paying for anything that would extend her life. or make what remains of it better! Don’t believe me, ask any Brit or Canadian how their system works.

It is worth remembering that the first approval needs to be by the FDA before any insurance company including Medicare will even consider coverage. That takes time to achieve the FDA approval then applying to Medicare et al. The FDA approved the Cochlear implant in 1984 and Medicare approved in 1986.