Hearing Insurance Benefits: From Testing To Hearing Aids And Beyond

Most people assume hearing insurance begins and ends with a quick hearing test, then they get blindsided by what’s actually covered. We sit down with Dr. Jill Copley while Sophia Yvette asks the questions patients are already thinking about: what counts as a true diagnostic hearing evaluation, which parts insurance may pay for, and why your benefits can look completely different depending on whether you have commercial coverage, Medicare, or a Medicare Advantage plan. If you’ve been Googling hearing insurance benefits, hearing test coverage, or hearing aid coverage, this conversation gives you a clear map of the terrain.

We talk through what “diagnostics” can include beyond the school-style beeps: speech testing, speech-in-noise testing, and middle-ear measures that check eardrum movement. Dr. Copley also explains when a referral is required (common with HMO plans) and why Medicare can be confusing, especially when the visit is tied to getting hearing aids versus evaluating a medical concern. From there, we compare commercial insurance with Medicare Advantage, including how Advantage plans often route hearing benefits through third-party discount programs that may reduce the device price while limiting follow-up care. 

We also get practical about hearing aid treatment costs: what insurance might pay for the devices, how technology levels and upgrades typically work, and why fittings, programming, adjustments, cleanings, and long-term maintenance matter as much as the hearing aids themselves. Finally, we cover what to do when your plan offers little or no hearing aid coverage, including private pay, payment plans, and local resources like the Texas Workforce Commission for people who qualify. 

If you’re in the DFW Metroplex, reach out to Total Hearing Care, and wherever you live, use this as your checklist for smarter benefit verification. Subscribe, share this with someone comparing plans, and leave a review so more people can avoid expensive surprises and hear better sooner.

To learn more about Total Hearing Care visit:
https://www.TotalHearingCare.com

Total Hearing Care
Multiple Locations Across the DFW Metroplex
(469) 809-4487

Transcript

Welcome And What We’re Solving

SPEAKER_00 0:00

Welcome to the Total Hearing Care Difference, where we help you experience life through better hearing. Hosted by the Experts of Total Hearing Care, a leading private audiology practice serving the DFW Metroplex, we are here to provide guidance on hearing loss, tinnitus, and the latest advancements in audiology. Transform your life through better hearing. Let's get started.

Insurance Benefits Beyond The Test

SPEAKER_01 0:28

Insurance benefits don't stop at the hearing test. Many plans include layers of support that patients never realize they have access to. Welcome back, everyone. I'm Sophia Yvette, co-host and producer back in the studio with Dr. Joe Copley. Dr. Copley, how's it been going today?

SPEAKER_02 0:47

Been going great. Thank you. How are you doing?

SPEAKER_01 0:50

I am also doing great. Now, Dr. Copley, hearing insurance benefits can cover far more than people expect. Can you walk us through what benefits look like from testing to hearing aids and even ongoing care?

Diagnostic Testing People Miss

Medicare, Advantage, And Commercial Differences

SPEAKER_02 1:05

Ooh, that's a big topic. But I'll I'll try to make it easy for people. So the first one is the diagnostics. And so audiologists are allowed to bill insurance companies for diagnostic evaluations. What that means is that people think of just a hearing test as what you did in school where there were some beeps and you raised your hand. And that's certainly part of it. But insurance also will cover some speech testing and speech and noise testing. It covers an evaluation to see how your eardrum is moving, things like that. And sometimes they will cover a cognitive screening, which in previous podcasts we talked about how important your brain is to hearing because it processes that information. So those things can be covered. Now, depending on your insurance, you may need a referral for that. So HMO insurance plans which require a referral to a specialist, we would need that referral in order to do that. Some plans don't cover these things. And so what you do is if they don't cover the diagnostics, then you just have to write it off. And sometimes they they don't. One of the companies that doesn't cover hearing testing or diagnostics for the purpose of getting hearing aids is Medicare. And so we charge a person a small amount out of pocket. Now, if your physician thinks there might be something medically problematic, like you have ear infections or something's going on with your ears, and you get a referral from a physician, then we can bill Medicare. So that gets kind of confusing, but sometimes it's covered and sometimes it's not. And that's with kind of all the insurance companies. Some of your commercial plans versus um, we haven't mentioned this yet, but Medicare Advantage plans. Medicare Advantage plans, um, if you're over 65, you probably have an understanding of what they do. They're an alternative to being on Medicare. Typically, they have lower premiums and lower deductibles, so you don't have to pay as much, but they have to have the same coverage as Medicare. And so those may pay for diagnostics as well. Commercial insurance has a lot of that follow-up care that you were talking about. So some of those plans, um, we do have codes for those for follow-up care. Unfortunately, Medicare, Medicare Advantage does not cover follow-up care. Um and that's just kind of, you know, that's that's a black and white part. Not all commercial insurance covers it, but we know for sure that Medicare, Medicare Advantage does not cover it.

SPEAKER_01 4:13

Yes. Now, how do plans differ when it comes to covering treatment costs?

Hearing Aid Coverage And New Billing Codes

SPEAKER_02 4:20

So treatment costs um will typically include the um the hearing aids themselves. And in a previous podcast, we talked about how some insurances cover it and some don't. For instance, Medicare does not cover it, but some commercial plans might. Um, and then things like uh Medicaid and workers' comp might, depending on the situation. And so when we check benefits for the hearing testing, we're also going to check for the hearing aids. Now, recently, just this year, um we have a lot of new codes to bill insurance for for audiology. And that includes coding for the consultation that we see you, programming the hearing aids, um, doing your follow-ups, seeing you for the hearing aid fitting. If you can believe it, none of that stuff was covered before this year. And so people had to pay out of pocket for that. Some of the plans will now pay for those codes. And so that's really nice. But so far it's just the commercial plans that are paying for those. Um, again, Medicare, Medicare Advantage does not cover that.

Tech Levels, Upgrades, And Discount Programs

SPEAKER_01 5:39

Wow. Now let's get into the different types of hearing aids or technology levels that are usually included in these benefit plans.

SPEAKER_02 5:51

So depending on the insurance coverage, typically insurance, if you have um insurance coverage, will usually cover something not necessarily the premium or standard of care product, but also it's typically not the most basic product. It's usually somewhere in the middle. And then people can choose if they would like to um get something better, if they would like to upgrade to something better. Um, I'm going to exclude Medicaid from that because Medicaid, you don't have that choice, but for other insurance, you do. You can do that. And workers comp, you can't. You have to accept what whatever those guys pay. But um, with regular insurance, you can. Now, Medicare Advantage, if they have insurance benefits, will probably be through a discount program. What that means is you're not actually getting insurance from the insurance company. You are going through a third party that provides the hearing aids, usually without follow-up care, just the hearing aids, and maybe your adjustment period at the beginning. And then you pay for those hearing aids, but you're paying a discounted rate that you might pay versus paying in full for all the services, all the warranty time, all the cleanings, all your visits, things like that. So that is available for people with Medicare Advantage, and that's probably on almost all plans that we've seen.

Follow-Up Care And What It Costs

SPEAKER_01 7:30

Now, are follow-up visits, adjustments, and cleanings only covered under the um medical advanced plans with the Medicare?

SPEAKER_02 7:41

So actually, follow-up visits aren't covered under the Medicare Advantage plans. Um typically, what happens for most companies is we bill for a total of the services. So we kind of average out the services over three to four years because that's typically what your warranty is. And we believe in treatment. So we know that you need ongoing care, whether it's checking for cleaning, sending your devices in for um maintenance every year, to have the manufacturer check them and make sure everything's going okay. Programs to help with understanding of noise, which is one of the major factors that people have difficulty with when they get hearing aids. So all of that is inclusive. Um, and usually that is not covered by insurance. But some of those initial follow-up visits and the fitting visits can sometimes, again, depends on insurance, um, be covered by a commercial policy.

SPEAKER_01 8:46

Now, final question for you, and we've covered some great information today, but what should someone do if their plan offers limited or no hearing aid coverage whatsoever?

SPEAKER_02 9:00

So um most people typically will still get um have to pay out of pocket, have to pay privately for hearing instruments, especially those that are on Medicare. Um there are other things that can can occur. I will say Texas is not necessarily the best state for coverage for people who don't have insurance coverage. But for instance, if you are working, um you can go through the Texas uh Workforce Commission and they can assist. Sometimes people who have hearing loss but are also blind, there are programs for them. But I would say most people are paying out of pocket. We do have um payment plans. I'm sorry, slip my mind for a second, that there are payment plans that you can have so you can split up your costs over time. Um, and that makes it a lot easier for people.

SPEAKER_01 10:04

Well, Dr. Copley, thank you for walking us through the full picture of hearing aid insurance benefits. This helps patients understand the value of their coverage from start to finish. We'll see you next time. Thank you so much.

How To Book And Final Takeaway

SPEAKER_00 10:21

Thank you for listening to the Total Hearing Care Difference. If you're in the DFW Metroplex and ready to take the next step toward better hearing, call 469 809 4487 to book an appointment or visit totalhearing care.com because when you hear better, you live better. See you next time.