The Hidden Downsides of a Hearing Aid Benefit: Why Basic Coverage Isn’t Enough

10/08/2024 | Insurance

For individuals dealing with hearing loss, the promise of a hearing aid benefit through insurance can seem like a lifeline. However, the reality of these benefits often falls far short of what people truly need.

While a hearing aid benefit may sound like a great deal, it may cover only the most basic technology with minimal follow-up care, leaving many individuals under-served and still struggling with hearing challenges.

This article explores the limitations of a standard hearing aid benefit and why you should consider pushing your insurance company for more comprehensive coverage that truly meets your needs.

The Problem With Basic Hearing Aid Benefits

A typical hearing aid benefit is often designed with cost control in mind, not the user’s experience or quality of life.

These benefits might cover a portion of the cost of hearing aids, but they rarely provide access to the advanced technology or comprehensive care necessary for most people with hearing loss.

Here’s why basic hearing aid benefits are often inadequate:

Coverage Limited to Basic Technology:

Most hearing aid benefits cover only the most basic technology, which often lacks the advanced features that significantly improve sound quality and user experience.

Minimal Follow-Up and Adjustments:

Achieving better hearing requires an ongoing and long-term relationship with a trusted, reputable hearing care provider that has helped many other people to achieve the outcomes that you are looking for. Basic insurance benefits often include only one or two follow-up visits, which is far from sufficient for most people. Without continuous support, many users struggle with poorly fitted devices, discomfort, and suboptimal hearing performance, leading to frustration and abandonment of the hearing aids altogether.

Inadequate Professional Care:

Hearing care involves more than just the device; it requires the expertise of audiologists and hearing care professionals. Unfortunately, the limited coverage provided by hearing aid benefits often restricts access to the necessary professional services, pushing users toward generic fitting services that may not meet their specific needs. A lack of personalized care can result in poorly adjusted devices that fail to deliver the expected improvement in hearing.

High Out-of-Pocket Costs:

Even with a hearing aid benefit, out-of-pocket costs can be substantial. Many insurance plans cap the benefit at a fixed dollar amount—often between $500 and $2,000 per ear—every two years. Given that the average cost of modern hearing aids with services ranges from $3,000 to $7,000 per pair, the benefit barely scratches the surface of the financial burden. This limited support leaves users paying the bulk of the costs themselves, often opting for subpar devices to save money.

Why Basic Hearing Aid Benefits Are Not Fit for Most People’s Needs

The shortcomings of hearing aid benefits highlight a fundamental problem: They are designed to minimize costs, not to optimize the user’s hearing experience.

The challenge is hearing healthcare providers are often asked to pick up the pieces and then deliver the bad news to the patient that they are not covered for the care that they need, or be stuck in the compromised position of desperately wanting to help but not being paid by the insurance company for the hours that are required to achieve optimal outcomes for the patient.

This is causing a lot of frustration throughout the hearing care industry, as insurance companies are continually squeezing the hearing care professional to do more for less and be poorly compensated for their work/expertise.

The top and bottom of it is that hearing aid benefits are not to the standard that they should be, and insurance companies are over-promising to you and under-delivering, resulting in everybody losing but them.

How to Advocate for Better Hearing Coverage

If you find that your current hearing aid benefit does not meet your needs, it is time to take action.

Here are steps you can take to advocate for better coverage from your insurance provider:

Request a Comprehensive Hearing Benefit:

Contact your insurance company and ask about options for expanding your hearing aid benefit. Highlight your specific needs and how they are not met by the current basic coverage.

Explore Additional Coverage Options:

Some plans offer supplemental hearing benefits or riders that can be added for an extra cost. These can provide access to higher-end hearing aids and more extensive professional care.

Appeal Coverage Denials:

If your request for advanced technology or extended care is denied, file an appeal. Provide documentation from your audiologist or hearing care professional to support your case.

Advocate for Policy Change:

Join consumer advocacy groups or organizations that push for better hearing aid coverage in health insurance policies. Your voice can help influence policy changes that benefit all individuals with hearing loss.

Save Your Money:

Opt out of higher premiums for sub-par hearing aid benefits and pay cash to the provider for your hearing aids. If the math adds up, you may find that over a five-year period you are spending less and getting the hearing you are looking for. Talk to your provider about your financial needs to determine if there is a treatment plan that meets your needs and budget.

In Summary

Hearing aid benefits may sound like a helpful perk, but they often fall short of providing the necessary technology and care that most people need to thrive.

Basic coverage typically includes outdated devices with minimal support, leaving users frustrated and still struggling to hear.

Do not settle for inadequate benefits—take control of your hearing health by advocating for more comprehensive coverage that includes advanced hearing aids, ongoing professional care, and personalized support.

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Erika Shakespeare CCC-A

Erika Shakespeare, CCC-A, specializes in pediatric and adult diagnostics and amplification. Working with adults to help manage tinnitus and hearing loss since 2002, she is an expert in both of these areas. Additionally, she is a pediatric audiology mentor and educator for pediatric audiologists across the country and is one of the most respected experts on pediatric audiology.

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