OPINION

Fair Hearing in Medicare

Congressional Democrats have advanced legislation expanding vision (H.R. 4665), dental (H.R. 4650) and hearing (H.R. 4618) benefits for Medicare beneficiaries with the recent passage of the Elijah E. Cummings Lower Drug Costs Now Act of 2019 (H.R. 3). 

For the most part, this is welcome news to the managed hearing care community. One, because the projected savings from H.R. 3 will find their way into Medicare and other health programs; and two, because it recognizes in a very public way that hearing health is essential to overall health and quality of life.

A few facts to consider:

— About 38 million Americans report some degree of hearing loss.

— As many as 1 out of every 3 people ages 65 to 74 has some form of hearing loss, and that number increases to about 50 percent of people above the age of 75.

— The annual financial impact of hearing loss is estimated to be over $100 billion.

A recent Bloomberg article stated, “Right now, the majority of Medicare beneficiaries either go without dental, vision, and hearing coverage or buy supplemental insurance.” That means that they likely forego regular hearing checkups and treatment until it is absolutely imperative — often with dire consequences.

For example, individuals with untreated hearing loss are twice as likely to be depressed than people with normal hearing or those who wear hearing devices. Hearing loss also is one of many factors that can lead to falls in people 65 and over. A mild degree of hearing loss triples the risk of an accidental fall. This risk goes up by 140 percent for every additional 10 decibels of hearing loss.

Obviously, increased insurance coverage for hearing devices is an important step to addressing this sizeable health concern. But it is not as simple as handing out one-size-fits-all hearing aids to any Medicare recipient with hearing loss. In order for hearing aids to successfully treat hearing loss, they must be as individualized as a pair of eyeglasses or contacts.

Consumer choice is paramount. Therefore, any federal legislation designed to improve access to hearing benefits in the United States must exclude hearing aids from the Medicare competitive bidding program.

As with other products categorized as medical devices versus durable medical equipment, consumers should be able to apply the full amount of their allowable benefit toward the purchase of devices that are best suited for their unique set of circumstances. Patients can purchase more features or devices costing beyond that allowance out of pocket. But they should be able to use the full allowable amount.

Additionally, we believe that any Medicare hearing coverage must reimburse for two hearing aids, preferably binaural, when clinically recommended. The benefits of binaural hearing aids versus monaural are improved localization ability, better hearing in noisy environments and prevention of auditory deprivation, a condition in which the brain of individuals with hearing loss loses the ability to interpret words.

Finally, as noted, hearing loss can have a profound effect on an individual’s quality of life. This is particularly true with seniors. Beyond falls and depression, loss of hearing can cause people to withdraw. No longer able to carry on conversations in noisy surroundings or just plain embarrassment about their condition can isolate individuals.

We strongly encourage Congress to consider the broader societal impact of hearing loss and its impact on co-morbidity as it works to establish hearing benefits under Medicare.

We applaud Pelosi and the House of Representatives for helping raise the profile of hearing health as essential to overall health. H.R. 3 takes an important step forward in recognizing the importance of hearing health, especially for senior Americans covered by Medicare, through proposed coverage for hearing exams and hearing aids.

The American Association of Payers, Administrators and Networks and its Hearing Network Alliance is eager to work with Congress to help shape bipartisan legislation that recognizes the ability of the hearing care plans and providers to deliver reliable, high quality, cost-effective care through market-based solutions. 

 

Julian Roberts is president and CEO of AAPAN, the unified, integrated voice for payers, TPAs, networks and care management in both the workers’ compensation and commercial/government health markets.

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