Staying up to date with what’s going on among family members and friends is essential to all of us, and being able to understand important information can be critical. When you don’t hear well, it is a struggle to keep up, and it hampers your quality of life as well as the capacity for independent living. An unfortunate statistic related by Medical Xpress shows that only one in five individuals diagnosed with a hearing loss get the necessary help that hearing aids can provide. A significant element preventing patients from obtaining this much-needed care comes from a lack of or uncertainty of the hearing care and hearing aid coverage provided by their insurance policy.

There is plenty of confusion following a diagnosis of hearing loss and my recommendation of hearing aids as a viable solution for my patients in the Houston area. Another problematic proposition for many of my patients relates to answering one of the most common questions I hear – “Does my Aetna policy cover hearing aids?” I cannot provide a quick and straightforward answer to that question, because it depends upon various conditions related to planning type, age, and other factors. Still, I have compiled some general information about different Aetna policies that might help.

Medicare Plans

National Institute of Deafness and Other Communication Disorders (NIDCD) statistics state, “Approximately one in three people in the United States between the ages of 65 and 74 has hearing loss, and nearly half of those older than 75 have difficulty hearing.” This means that a majority of hearing-loss patients have attained the age where they have Medicare eligibility. The fact that Medicare does not provide coverage for hearing aids creates a lot of problems, but most insurance companies provide for coverage through various plans and Medicare supplement plans.

Medicare Advantage (HMO and HMO-POS)

Each of these Aetna plans is a health maintenance organization (HMO) options with a primary care physician who manages your health care. Members can freely choose from providers within the HMO network, but limitations and restrictions to coverage benefits apply when choosing providers outside it. Both of these Medicare supplement plans provide some hearing care coverage to varying degrees, with the only differences being that Aetna’s HMO-POS plans are slightly less restrictive when it comes to choosing providers outside the network.

Medicare Advantage (PPO)

The Medicare Advantage plan from Aetna is a preferred provider organization (PPO) package, which does not require the selection of a care provider within the network and does not require a referral to a hearing care specialist. The Advantage PPO plan also provides varying degrees of hearing care coverage.

Medicare Advantage Dual Special Needs (DSNP)

Like the other Medicare supplement plans already examined, Aetna’s Medicare Advantage Dual Special Needs supplement plans also provide varying degrees of hearing care and hearing aid coverage. The added benefit of combining your prescription drug and medical benefits into one plan is available only to those who meet specific low-income criteria.

Non-Medicare Plans

Most private insurance companies do not provide coverage for hearings aids for a variety of reasons, according to Healthy Hearing. A significant reason for this is the fact that the majority of individuals who require auditory assistance to correct hearing loss fall within the age groups covered by Medicare, further complicating hearing aid coverage issues. However, there are often various types of coverage riders, partial coverage options, discounts, or other assistance to help pay for hearing aids.

Aetna’s non-Medicare insurance plans comply with the mandate to provide hearing care for children in the state of Texas in all of its available packages. Coverage and benefit levels vary in accordance with selected copayment, deductible, and coinsurance options along with attached riders for adults on other plans offered by Aetna. Member discounts and specialized programs available within and outside their membership network might also provide payment assistance.

Clarity Hearing Service Solutions

Knowing whether your Aetna Insurance policy covers hearing aids might require a lot of research and stress. Still, Clarity Hearing is here to help provide answers to your insurance coverage questions and bring peace of mind. Our team has the experience and expertise to find out exactly what benefits are available from your policy for covering hearing aids and hearing care costs.

I advise my patients with Aetna insurance to fill out our online form and allow us to determine the insurance copayment, deductible, or coinsurance levels applied to your specific plan along with any included network discounts or restrictions. When it comes to hearing aids and your overall hearing care, my Clarity Hearing associates and I dedicate ourselves to meeting all of your needs.

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Dr. Scott Marquardt - Doctor of Audiology & CEO of Clarity Hearing

Dr. Scott Marquardt - Doctor of Audiology & CEO of Clarity Hearing

Scott Marquardt is the owner of Clarity Hearing and a highly skilled audiologist who has been in practice for over 20 years. Dr. Marquardt earned a master’s degree in audiology from Lamar University in Beaumont, Texas, and a doctorate from A.T. Still University. He is a member of the American Speech Language Hearing Association and a fellow of the American Academy of Audiology. He and the team offer comprehensive hearing healthcare services and specialize in the care of tinnitus, imbalance, and auditory processing disorders.