Hearing Associations Recommend Increased Transparency

Earlier this year, the American Academy of Audiology (AAA), the world’s largest professional organization of, by and for audiologists representing the interest of audiologists, submitted comments in response to the Centers for Medicare and Medicaid (CMS)’s annual proposed rule for Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program on ways to increase transparency in Medicare Advantage (MA) around supplemental hearing benefits.

The Academy of Doctors of Audiology (ADA), a leading national association dedicated to evidence-based audiologic and vestibular care represents audiologists across the US who treat millions of Medicare patients each year, also released recommendations to CMS on best business practices of hearing aid manufacturers and manufacturer-owned hearing benefit administrators.

Let’s look at the recommendations from both organizations and how their implications impact the way health plans should think about their hearing benefits. 

Is your hearing benefit design clear to your members? For some, AAA and ADA don’t think so. MA plans often offer supplemental benefits not available in traditional Medicare, but coverage isn’t always clear to members.

• Some coverage offered in MA plans is not an actual funded benefit but rather a discount plan. Some MA plans provide members with access to discounted prices on hearing aids and related services. The plan may not cover the entire cost of the hearing aid, and beneficiaries still need to pay the discounted amount out-of-pocket (OOP).

• Many times, the insurer or hearing benefit administrator mischaracterizes this OOP amount as a “co-pay.” Other MA plans offer a true funded benefit or more comprehensive coverage that covers a portion or the full cost of hearing aids and related services up to a certain limit or maximum amount.

A significant problem and an example of a lack of transparency is that most consumers don’t recognize the difference between these types of benefits and don’t fully appreciate the impacts this may have on OOP costs.

Does Your Hearing Benefits Administrator Offer a Transparent Benefit to Your Members?  

At Amplifon, we offer three types of plans:

• Discount: Our health plan clients do not contribute funding to the hearing benefits. As the global leader in distribution of hearing aids, we leverage our negotiating power with leading brands to secure significant discounts. Through our discount program, we proudly offer our members an average savings of 68% off MSRP¹, ensuring that quality hearing solutions are accessible and affordable.
  
  
• Co-pay: We work with health plan partners to establish groups of tiered hearing aids. To simplify how benefits are administered, members are given multiple levels of hearing aid options characterized by prices members pay. To stay compliant with CMS, we work with our clients to ensure that they contribute meaningful funding that provides savings to members.
  
  
• Allowance: We work with clients to establish a set amount of funding ($1,000, $2,000, etc.) paid to members as part of their hearing aid purchases.

Does your hearing benefit administrator offer your in-network hearing providers in your vendor’s network? It may not, according to AAA.

Because hearing benefits are typically administered by a vendor, there are audiologists who may be “in-network” with the insurer or MA plan but “out of network” with the vendor that administers the hearing aid benefit for the plan. This results in consumer confusion as well as fragmented patient care.

How We Operate

• All of our network providers are in-network with all of our insurers. We encourage exclusivity with our health plan partners to reduce confusion and in order to provide the best patient experience possible. 

Currently, there are hearing aid benefit incentives that encourage providers towards higher cost hearing aids, even if that’s not in the best interest of patients.

How We Operate

• Amplifon is the only hearing administrator with a universal reimbursement rate that pays providers the same amount regardless of the technology tier dispensed.²
• This places the focus on quality of care rather than maximizing profits.