Hearing exams and hearing aids, Medicare

Applies to:

Individual Priority Health Medicare Advantage plans

Definition

All individual Priority Health Medicare Advantage plans include Medicare-covered diagnostic hearing and balance evaluations performed by a provider to determine if medical treatment is needed.

Additionally, they include a non-Medicare covered annual routine hearing exam at no charge and up to two hearing aids per year with TruHearing. Non-Medicare covered routine hearing is administered by TruHearing.

Covered benefits

Coverage runs from Jan. 1 through Dec. 31 of each calendar year, the same as the member's Medicare Advantage plan.

In-network benefit:

Medicare-covered hearing:

For all individual Priority Health Medicare Advantage plans, Medicare-covered diagnostic hearing and balance evaluations are billed as part of the office visit and the members will be responsible for their PCP or specialist copay.

Non-Medicare covered routine hearing:

All individual Priority Health Medicare Advantage plans (except D-SNP and PriorityMedicare Vital) cover the following with a TruHearing provider:

  • One routine hearing aid exam, per year, at 100%
  • Two hearing aids, one per ear, per year. There are four levels of hearing aids, from top hearing aid manufacturers, ranging from basic to premium. Members pay a copay of $295, $695, $1,095 or $1,495 per aid, depending on the level chosen. Members must see a TruHearing provider to use this benefit. To access their benefits, they should call TruHearing at 833.714.5356 from 8 a.m. – 8 p.m. Monday through Friday to schedule an appointment.

The PriorityMedicare D-SNP and PriorityMedicare Vital plan covers the following with a TruHearing provider:

  • One routine hearing aid exam, per year, at 100%
  • Two hearing aids, one per ear, per year. Members pay $0 for advanced aids that come in various styles/colors and are equipped to handle challenging listening environments. Members must see a TruHearing provider to use this benefit. To access their benefits, they should call TruHearing at 833.714.5355 from 8 a.m. – 8 p.m. Monday through Friday to schedule an appointment.

Each hearing aid purchase includes the following for all individual Priority Health Medicare Advantage plans:

  • 3 provider visits within first year of hearing aid purchase (first visit is for the fitting and adjustment, two additional visits for any adjustments to the programming which might need to be made)
  • 45-day trial period
  • 3-year extended warranty
  • 48 batteries per aid for non-rechargeable models

For details, check the member Certificate of Coverage:

Out-of-network benefits

Medicare-covered diagnostic hearing and balance evaluations are billed as part of the office visit and the members will be responsible for their PCP or specialist copay/coinsurance, and deductible (if applicable).

Non-Medicare covered routine hearing is only covered through TruHearing providers.

Medicare hearing benefits billing

Participating providers for non-Medicare covered routine hearing:

A participating provider is a provider who is contracted with TruHearing.

Submit claims directly to TruHearing via the TruHearing provider portal (Echo) for payment.

Join the TruHearing network.