Our response to COVID-19
How we're keeping our patients & caregivers safe
LEARN MORE

Medicaid Covered Hearing Aids in PA

October 31, 2021

Medicaid is a healthcare program that the federal and state governments jointly fund. It provides free or discounted health coverage for vulnerable people in society with different treatment needs. These people include children, the elderly, pregnant women, disabled persons, and low-income families.

This article looks at what hearing aids are and whether they are covered under Medicaid in Pennsylvania (PA). First, let’s define what a hearing aid is.

What's a Hearing Aid?

A hearing aid is a small microphone or amplifier worn behind or in the ear by those with hearing impairment. It makes sounds and speeches loud enough for the wearer to hear them. When introduced immediately after a diagnosis of hearing loss, hearing aids can assist children and toddlers in developing communication skills.

Depending on the state you live in, Medicaid may cover the costs of hearing aids.

Will Medicaid in Pennsylvania cover hearing aids?

States run their own individual Medicaid programs and determine their coverage services. If you're a resident of Pennsylvania, here's what to expect regarding Medicaid coverage for hearing aids:

For Children

If you're aged 21 and below and enrolled in Medicaid, you can have your hearing aids covered under the health program. Medicaid covers an array of services for kids and adolescents in danger of hearing loss, including:

·    Periodic auditory tests or whenever a parent or doctor believes the child has an underlying problem

·    Assessment for hearing aids

·    Auditory services that are considered medically necessary, like cochlear implants, further testing, replacement batteries, and hearing aids.

For Adults

Unlike the mandatory coverage for children enrolled in Medicaid, coverage for adults with hearing loss is not a mandatory service in Pennsylvania. However, your Medicaid plan might offer such services, including hearing aids. Get in touch with your in-network provider to learn more.

Wondering what questions to ask your plan representative? Here are a few:

·    Does the insurance cover the full cost of buying hearing aids?

·    Is the coverage only applicable to specified hearing aid models?

·    If they don't cover the full cost, what's the specified allowance for hearing aids?

·    Do they also cover the cost of hearing aid repair services, ear molds, and batteries?

·    Do they offer specialized services for testing, programming, and adapting hearing aids for kids?

·    Are you required to buy from specific providers?

·    What are the requirements for coverage? Do you need to have a specified degree of hearing loss for you to be eligible for coverage?

After confirming that you or your child qualify for hearing aid coverage under Medicaid, you can go ahead and schedule an appointment with your doctor. Let’s take a closer look at the process that you should follow to get a hearing aid.

Process of Getting Hearing Aids for Children

Before applying for hearing aid coverage, your child must have a diagnosis as well as medical clearance. We’ve outlined the process for getting hearing aids for kids under Medicaid.

1.      Schedule an appointment with an audiologist or otologist.

Book an appointment for your child to visit an audiologist as well as an otolaryngologist or otologist. These specialists are trained at diagnosing hearing problems, and they know how to best help children with hearing difficulties.

The audiologist will use a tool called an otoscope to look inside your child's ears. After checking the way the ear looks, the next process is to find out how the ear is functioning.

The first examination is known as tympanometry (eardrum test). It inspects how the eardrum moves and determines the type and cause of hearing loss. It also determines whether a hearing aid can help with the hearing loss. A functioning eardrum typically moves back and forth when sound enters the ear.

During the procedure, a tympanometry is placed inside the ear for a couple of seconds. It detects eardrum movement, which appears as a series of lines on the screen or printed paper.

2.      Get the diagnosis script signed.

The audiologist will show you your child’s hearing ability based on an audiogram chart. The health practitioner should duly sign the diagnosis script. For Medicaid to cover the cost of hearing aids, the hearing test must have been conducted within the last six months.

The diagnosis script should explicitly indicate the need for hearing aids for Medicaid to cover these costs. The doctor's report will recommend a hearing aid for your child if they need one. Of course, this recommendation will be based on the type and extent of the child’s hearing incapacity, plus the structure and outline of his or her outer ear.

Some common types of hearing aids include:

·         Behind-the-ear style hearing aids - These are often recommended for young children for the following reasons:

o   These are durable and flexible.

o   These feature a tamper-resistant battery access door. This is to make sure that your child cannot access the batteries.

o   These use bespoke ear molds, which can be easily customized as your child grows.

·         In-the-ear design hearing aids - These are recommended for adult use because:

o   A child’s ears are too small and thus not suited for in-the-ear design hearing aids.

o   It takes some time for these to be re-cased once your kid outgrows them.

o   Constantly adjusting the size of the casing doesn't come cheap at all. You have to be prepared to cover the high costs.

o   This design typically doesn't feature tamper-resistant battery access doors. It poses a significant risk to the child if they can access the battery and start playing with it.

At this point, you're probably curious to know how much a hearing aid costs. Read on to find out.

How much do hearing aids cost without insurance?

Hearing aid costs are high, especially if you don't have health coverage. These range from $1,000 to $6,000 for a single device, based on the technological level.

A majority of people often need hearing aids for both ears, so you can imagine the overall cost. The high price tag is often an obstacle for most people who need hearing aids.

Some common factors that affect the price of hearing aids are:

Features

The level of technology and included features largely determine the cost of hearing aids. However, the technology you get for your money is far better currently compared to what you'd get a few years ago. A previously sophisticated hearing aid is now deemed basic technology.

Hearing aids also come in varieties to meet patients’ different requirements and budgets. Typically, an advanced-level device will cost you more. This is because it features all the latest and best features, including superior noise reduction as well as wireless capabilities.

Bundled Services

In some instances, the cost of a hearing aid may include the device itself plus the services of the specialist. As a result, the amount you pay covers the costs of hearing assessments, initial fitting services, any needed follow-up fine-tuning, and periodic cleanings. Some specialists may also factor in the supply of batteries for your hearing aid in the overall cost.

Why is bundling a common feature in hearing aid pricing? Well, your hearing capabilities may change over time, and your hearing aid may need to be modified. Plus, you may need hearing aid repair down the line and require follow-up visits to the specialist. This means you're paying for the services of a professional on top of the hearing aid technology.

What if I need hearing aids but can't afford it and insurance doesn't cover these?

No one should be stuck with a hearing problem because they can't afford to buy hearing aids. If you're struggling to pay for the costs associated with getting a hearing aid, below are two resources that can help you afford these devices.

AUDIENT Program

·         Telephone: 1-866-956-5400 x2

·         Website: www.audientalliance.org

Audient is affiliated with the Northwest Lions Foundation for Sight and Hearing. It's administered by EPIC Hearing Healthcare. If you’re a low-income individual, Audient partially covers the expense you incur from getting a hearing aid. These include the device itself, hearing aid fitting, and follow-up appointments.

Easter Seals

·         Website: www.easterseals.com

The Easter Seals network is made up of over 400 local service centers with varying services. Some of these service centers assist low-income adults and children with hearing aids and other rehabilitative devices. Visit their website and find your local Easter Seals office to get contact information.

Overcome Your Hearing Problem Today by Getting Affordable Hearing Aids

Children younger than 21 years enjoy Medicaid coverage for an array of auditory services, including hearing aids. This is irrespective of the state they live in. On the other hand, adults enrolled in the Pennsylvania Medicaid program don't enjoy this privilege and have to check with their individual plans.

Don't fret if you need a hearing aid but don’t have the funds for it. Besides Medicaid healthcare coverage, there are several charitable organizations that provide hearing aids at discounted rates. Notable examples include Audient and Easter Seals.

Ultimately, your local hearing care expert can provide you with the best advice on how to find sources of hearing aid funding.