The Rising Popularity of Medicare Advantage and Implications for Audiologists

The Kaiser Family Foundation recently released a study of the 2020 Medicare Advantage plans and reported that 83% of the plans will offer some degree of coverage for hearing aids and related services.  In contrast, traditional Medicare (Part B) does not currently offer hearing, dental or vision coverage.

Under traditional Medicare, benefits are provided and premiums are set by the federal government.  Benefits are the same for all enrollees, and there are no pre-existing limitations or waiting periods.  There are no provider networks, and beneficiaries can use any healthcare provider who accepts Medicare.  Also, there are no requirements for a referral in order to visit a specialist.

Medicare Advantage Background and Growing Popularity

Medicare Advantage was created as a private market insurance alternative to traditional Medicare in 1997 and at that time was referred to as Medicare Choice.  The name was subsequently changed to Medicare Advantage (MA) in 2003 as part of the Medicare Modernization Act.  MA plans are not sold or managed by the federal government, although the government does set rules and guidelines for these plans.  MA plans must offer the same benefits provided under traditional Medicare, but they are allowed to offer additional services, including hearing, vision and dental. Beneficiaries may have to pay a higher premium or out-of-pocket costs for these additional services.

The popularity of MA has been steadily increasing over the past few years, and approximately 34% of Medicare beneficiaries were enrolled in an MA Plan in 2019.  Looking ahead, thirteen insurers will be entering the MA market for the first time, and 3,148 MA plans will be offered in 2020—a 15% increase over the number of plans in 2019.

What Does This Mean for Audiologists?

MA plans that offer a hearing aid/services benefit typically utilize a third-party administrator who serves as an intermediary between the insurer and hearing health providers.  Third party administrators are also responsible for creating provider networks, contracting and reimbursement.  Reimbursement under managed care plans may be lower based on the premise that coverage is limited to smaller provider networks and therefore participating audiologists will make up the difference in volume.

It is critical that audiologists review these third-party contracts very carefully.  The Academy, along with the American Speech-Language-Hearing Association and the Academy of Doctors of Audiology, previously issued a joint statement to members on the importance of careful review of these contracts to avoid potential pitfalls.  With the expansion of MA plans and the increasing administration of hearing aid/services benefits by third party administrators, audiologists should revisit the joint statement for tips on how to best navigate these contracts.