Medicare/Medicaid

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Medicare/Medicaid

1965 Medicare and Medicaid were enacted as Title XVIII and Title XIX of the Social Security Act, extending health coverage to almost all Americans aged 65 or older (e.g., those receiving retirement benefits from Social Security or the Railroad Retirement Board), and providing health care services to low-income children deprived of parental support, their caretaker relatives, the elderly, the blind, and individuals with disabilities. Seniors were the population group most likely to be living in poverty; about half had insurance coverage.

Medicare is the federal health plan for citizens 65 years of age and older and/or those with significant disabilities. Medicare reimbursement rates are determined at the federal level under the auspices of the Centers for Medicare and Medicaid Services (CMS).

Medicaid provides medical assistance for qualifying individuals with low incomes and few resources. Medicaid is funded jointly by State and Federal governments in order to provide States the ability to offer adequate medical care to those in need. Medicaid is run within broad federally mandated guidelines which allow states the flexibility to establish their own eligibility standards, determine the type, duration, and scope of services, and set the rate of payment for services. As a result, benefits and programs vary considerably from state to state.

For more information, see:



Medicaid Coverage of Hearing Aids

What is Medicaid?

Title XIX of the Social Security Act outlines a program to provide medical assistance for certain individuals with low incomes and few resources. The program, known widely as Medicaid, is federal law and is funded jointly by State and Federal governments in order to provide States the ability to offer adequate medical care to those in need. Medicaid is run within broad federally mandated guidelines which allow states the flexibility to establish their own eligibility standards, determine the type, duration, and scope of services, and set the rate of payment for services. As a result benefits and programs vary considerably from state to state.

This research details the coverage of hearing aids and related services under Medicaid programs in the fifty states. Hearing health services are optional under Federal guidelines for minimum coverage and as a result many states do not cover hearing health services for adults.

Children are covered by a federally mandated program referred to as EPSDT, (Early and Periodic Screening, Diagnosis, and Treatment program) which provides for hearing health services as well as other services for eligible children up to the age of 18 in all states, unless otherwise listed. Individuals interested in the Medicaid services should contact their state’s Medicaid office using the information provided in the database.


CMS Final Rules Cover the Cost of Bone-Anchored Hearing Devices

November 15, 2014

October 31, 2014: The Centers for Medicare and  Medicaid Services (CMS) issued a final rule that codifies the Medicare policy guidance when a device is not subject to the hearing aid exclusion. The rule finalizes that certain auditory implants, including cochlear implants, brain stem implants, and osseointegrated (bone-anchored) implants, do not meet the definition of hearing aids that are excluded from coverage.

The final rule was published in the November 6, 2014, in the Federal Register and can be downloaded from http://www.ofr.gov/OFRUpload/OFRData/2014-26182_PI.pdf (starting on p. 419).

Direct any questions to the CMS Office of Legislation at 202.690.8220 if you have any questions.


HLAA Opposes CMS’ Proposed Rules on Bone-Anchored Hearing Devices

September 10, 2014

September 2, 2014, Hearing Loss Association of America filed comments with CMS (Centers for Medicare and Medicaid Services) in opposition to the proposed roll back of rules that would disallow Medicare coverage for bone-anchored hearing devices. We argued that these devices should be considered prosthetic devices under the rules, and that the coverage should include both osseointegrated devices and any innovations that are developed to help those who cannot successfully use hearing aids, such as dental-anchored conductive devices.

These proposed rules could hurt many people who would benefit from bone anchored devices, and those people who are already have these devices who may no longer be able to afford to have them repaired or upgraded. It’s not clear where people who could use these devices will turn if the CMS proposed rules are adopted.

Over 11,000 people signed a petition that specifically asked CMS to cover the Baha, osseointegrated implant system.  And over 4,000 comments were sent to CMS on this docket, although to be sure, there were several other issues teed up in this Notice of Proposed Rulemaking, making it difficult to get a count of the number of comments on the reclassification of bone-anchored devices as hearing aids. http://www.regulations.gov/#!docketDetail;D=CMS-2014-0092

HLAA sincerely hopes that CMS will reconsider this proposed rule. If the rule is adopted as is, it could impact the availability not only for Medicare patients, but for people who rely on private insurance as well, because private insurers tend to do as Medicare does. To classify these devices as hearing aids, would not only be wrong, it would relegate this technology to those who can afford these devices out of pocket.

Read HLAA Comments filed.


CMS Proposes Rule Change Eliminating Medicare Funding for Bone-Anchored Implants
Comments Due September 2, 2014

August 13, 2014

HLAA is concerned about the proposed roll back of rules by CMS (Centers for Medicare and Medicaid Services)  that would disallow Medicare coverage for bone-anchored hearing devices. These proposed rules could hurt many people who would benefit from bone anchored devices, including those who have no other option to turn to. If the rule goes forward intact, it could impact the availability not only for Medicare patients, but for people who rely on private insurance as well. In short, those people who don’t have thousands of dollars to spend on implants will have few places to turn to simply be able to hear.

Background
When the law enacting Medicare was drafted, language was written that specifically excluded coverage for hearing aids: Medicare will not pay for any part A or part B expenses incurred for items or services related to “hearing aids or examination for the purpose of prescribing, fitting, or changing of hearing aids.”

In 2005, CMS issued a notice indicating that Medicare contractors will pay for osseointegrated (bone-anchored) auditory and brainstem auditory devices as prosthetic devices when indicated, that is, where hearing aids are medically inappropriate or cannot be used. Osseointegrated devices were defined as devices implanted in the skull that replace the function of the middle ear and provide mechanical energy to the cochlear via a mechanical transducer. Consumers know these devices as the Baha the Pronto.

Because of Medicare’s inclusion of Osseointegrated implants, some private insurers have also covered these devices. Thousands of people in the U.S. have benefited from these devices, saying they are “life changing.” 

On July, 11, 2014, CMS posted a request for comments on a proposed rule change: they have come to the conclusion that all air or bone conduction hearing devices, whether external, internal or implanted, including middle ear implants, dental anchored bone conduction devices and other types of external or non-invasive devices are hearing aids, and thus, not covered under Medicare.

HLAA will be filing comments with CMS in opposition to this new rule. You too can send in comments, too.

For more information:
The Cochlear Corporation has additional informant and has linked their webpage to the comments page for CMS and a petition on Change.org.
http://www.change.org/petitions/centers-for-medicare-medicaid-services-dept-of-health-human-services-continue-coverage-for-the-cochlear-baha-implant-system-a-life-changing-hearing-solution

http://www.helpnowhearalways.com

Oticon, the maker of Pronto another bone-anchored hearing device, has also weighed in
http://oticonmedical.wordpress.com/2014/07/24/important-message-to-bone-anchored-hearing-system-users

Consumers can file comments!
Comments can be filed at http://www.regulations.gov and should refer to file code CMS–1614–P, 42 CFR Parts 405, 411, 413, et al. Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; Proposed Rule, clarify the statutory Medicare hearing aid coverage exclusion and specify devices not subject to the hearing aid exclusion.

The notice can be found at:
http://www.gpo.gov/fdsys/pkg/FR-2014-07-11/pdf/2014-15840.pdf  pages 40295-40297

Comments are due no later than 5 pm on September 2, 2014.

If you need help, contact advocacy@hearingloss.org


Hearing Aid Coverage Under Medicare: You CAN Make a Difference!

April 2014

In October 2013, HLAA sent out a letter in support  for a bill introduced in the US House of Representatives that if passed would provide hearing aid coverage under Medicare.

Introduced by Representative Matt Cartwright from Pennsylvania, the Help Extend Auditory Relief Act of 2013, the HEAR Act (HR 3150), would:

  • amend the Social Security Act to include Medicare coverage for hearing rehabilitation, including a comprehensive audiology assessment to determine if a hearing aid is appropriate, a threshold test to determine audio acuity, and various services associated with fitting, adjusting, and using hearing aids.
  • extend Medicare coverage to hearing aids, defining them as any wearable instrument or device for compensating for hearing loss.

The bill has picked up 20 co-sponsors but will surely need more to for this bill to move forward. To do that, members of the US House of Representatives need to hear from you. They need to know how this bill would change your life, and the lives of so many others.

[Read more]


Medicaid Coverage for Hearing Aids State by State

April 2012

Compiled on the Medicaid Regulations page is the coverage of hearing aids and related services made available to eligible Medicaid recipients in each state. Since the states often make revisions to the scope of their Medicaid benefits, recipients are cautioned to check their state’s Medicaid offices for possible updated coverage.