In 2019, the most recent year with reliable data, over 75 million Americans relied on Medicaid for their healthcare. Many were adults and seniors. So it should come as no surprise that many Medicaid recipients, like our CDPAP patients, are also in need of a hearing aid.
So, how do you get a hearing aid via Medicaid? And what types of devices should you be looking at? We’re about to take a closer look, and find out. Here’s everything you need to know about Medicaid covered hearing aids in New York.
How Hearing Aids Work
Hearing aids are designed to help improve hearing for people who have experienced hearing loss due to damage in the inner ear’s hair cells. This is not the only type of hearing loss, but it’s commonly caused by disease, injury, exposure to loud noises, and even ordinary aging. It’s the most common type of hearing loss by far among seniors.
Hearing loss due to hair cell damage is caused sensorineural hearing loss. These cells work by picking up vibrations from the air and transferring them to nerves deeper in your ear. When the cells are damaged, they’re not able to transfer vibrations as effectively.
With sensorineural hearing loss, it’s as if someone literally turned the volume down on your entire life. This can make it hard to understand conversations with your loved ones, and difficult to perform many jobs. It can even put you in danger if you can’t hear warning sounds like a car horn.
A hearing aid counteracts your hearing loss by boosting the volume. While hearing aids have different designs, they all contain three main parts: a microphone, an amplifier, and a speaker. The microphone picks up sounds from your environment and transmits them to the amplifier. The amplifier boosts the volume and plays it back through a speaker for you to hear.
Depending on the design, hearing aids can use one of two main types of technology: analog and digital.
Analog hearing aids convert sound directly into an electrical signal with a similar waveform. The amplifier then exaggerates the peaks and valleys to make the sound louder. In other words, it increases the amplitude of the wave, or amplifies it!
An analog hearing aid can be customized to perform better for individual users. Depending on the device, an audiologist may be able to choose from a few preset settings, or they may be able to fully customize the programming. Analog hearing aids are an older technology, and tend to cost less than digital hearing aids.
In a digital hearing aid, the sound wave is converted into a strings of 1’s and 0’s. This digital data is then read by the amplifier, and the volume is increased.
Digital technology allows an audiologist to better fine-tune a hearing aid for a particular purpose. For example, this kind of aid can be focused in a particular direction, while an analog aid can’t. You can even take advantage of advanced, high-quality audio technology like Dolby Digital. These hearing aids usually cost more than analog hearing aids, but the benefits can be well worth the added expense.
Types of Hearing Aids
In addition to using digital or analog technology, there are several other ways to classify hearing aids. Here are some terms you may want to discuss with your hearing specialist.
Monaural Hearing Aids
Monaural hearing aids are designed to work in a single ear. They have traditionally been used for treating patients with monaural hearing loss, which refers to hearing loss in one ear only.
Until recently, the vast majority of hearing aid patients were fitted with a monaural hearing aid. The reason is simple. Most people, even people with hearing loss in both ears, can get along just fine with a single hearing aid.
However, recent research has muddied the waters a bit. Bizarrely, it seems that patients with hearing loss in both ears are, in fact, usually happy with a single hearing aid. On the other hand, patients with monaural hearing loss can actually suffer from using a monaural hearing aid. For reasons that are not yet understood, using a hearing aid in the affected ear may cause the unaffected ear to lose hearing.
Binaural Hearing Aids
Binaural hearing aids are designed to be used as a pair, in both ears. This type of hearing aid has gained prominence in recent years, for patients with hearing loss in either one or both ears.
Based on what we’ve said, it might sound like binaural hearing aids are always better. However, that’s not always the case. There are many factors that determine which type of design is better for an individual patient.
Remember, the goal is to replicate the normal experience of hearing clearly through both ears. Only by working with a doctor can you determine which design is most likely to achieve that result. This is one of many reasons it’s vital to speak with your doctor about your hearing aid.
In-Ear Hearing Aids
In-ear hearing aids are designed to fit inside the outer ear. They usually look like wireless earbuds, with a hard plastic shell, sometimes with a soft tip for comfort. In-ear hearing aids are popular due to their small size and discreet profile. They’re still large enough to contain extra circuitry, though.
For example, a telecoil can be used to amplify phone calls, or to receive PA announcements in many public facilities. Most theaters, conference centers, and churches are equipped to work with this technology.
That said, growing children are usually not given in-ear hearing aids. The reason is that the aids must be sized for an individual. For a child, this would mean getting a new set of hearing aids every year, or even more often.
Behind-the-Ear Hearing Aids
Behind-the-ear hearing aids have the largest design of any variety. In addition to the part that sits in your ear, there’s a large hook, and often a battery case, wrapped around the back of your ear. All the electronics are housed in the case, with only a very small speaker in the ear tip.
This type of hearing aid can be worn by people of all ages, even small children. It’s also the easiest to take on and off, and to change or charge the battery. And because of the large size, you can use other circuitry like a telecoil.
There’s one variant of behind-the-ear hearing aid that deserves special mention: the open-fit hearing aid. These hearing aids don’t have a traditional ear tip. Instead, sound is transferred through a narrow tube that runs into the ear canal.
Behind-the-ear hearing aids are often used by people who experience a lot of earwax buildup, since the wax is easier to clean from this design. They also make it easier to equalize pressure, so they can be more comfortable when flying.
Canal Hearing Aids
Canal hearing aids fit directly into the ear canal, where they are completely concealed. This has the benefit of being entirely invisible, so strangers won’t even know you’re wearing a hearing aid. As a result, canal aids are popular with professionals who frequently have to work with the public.
Because of their small size, these hearing aids can be difficult to remove without a visit to your doctor. You also won’t be able to make any adjustments on your own, and the housing is too small for a telecoil. In addition, canal aids aren’t powerful enough for people with severe hearing loss, and they’re not suitable for children.
As you can see, while canal hearing aids may sound like the ideal solution, they have some definite limitations. This explains why in-ear and behind-the-ear models remain so popular with the general public.
Implanted Hearing Aids
Implanted hearing aids work completely differently from other types. Instead of boosting the volume of the sound going into your inner ear, they physically increase the vibrations. One type of implant, a middle ear implant (MEI), can be attached to one of the small bones inside your ear. It actually moves the bones by pushing on them, directly amplifying the vibrations that enter your inner ear.
Another type of implant is a bone-anchored hearing aid (BAHA). These attach to a different bone behind your ear, and send vibrations directly through your skull to your inner ear. Because it bypasses the middle ear altogether, a BAHA can be used to treat many middle ear disorders.
Keep in mind that implanted hearing aids require surgery, and any surgery is inherently risky. You’ll need to discuss the risks with your doctor before determining if this is the right choice for you. Also, BAHA devices are considered prosthetics, not hearing aids. So none of what we’re about to say about Medicaid hearing aid coverage applies to them.
Does Medicaid Pay For Hearing Aids For the Elderly in NY?
In order to receive hearing aids through Medicaid, elderly New Yorkers must be eligible for Medicaid. If you’re not, it would be a Medicare issue, which is a whole different can of worms.
Assuming you have Medicaid coverage, the first step to getting a hearing aid is visiting your doctor. You’ll need to get a referral to either an audiologist or an ear, nose, and throat doctor (ENT).
The ENT or audiologist must then perform a hearing test that meets a set of national standards. Make sure your specialist is aware that you’re a Medicaid recipient, so they can perform the correct set of tests and meet all the requirements.
If your specialist determines that you require a hearing aid, they can do one of two things. They can either write a general recommendation, or prescribe a particular type of hearing aid. If they write a specific prescription, they must also provide test results showing why that particular model is required.
What Kind of Hearing Aids Does Medicaid Cover?
For qualified New Yorkers, Medicaid will cover all the costs related to getting and using a hearing aid. This includes exams, fittings, replacement hearing aids, repairs, and follow-up visits.
So, who is a “qualified” New Yorker? To qualify, you must meet at least one of the criteria:
● Hearing loss of at least 30 dBHL in the better ear, for the pure tone average of 500, 1000 and 2000 Hz.
● A spondee threshold of at least 30 dBHL in the better ear, when the doctor is unable to establish a pure tone average.
● Hearing loss is less than 30 dBHL in both ears at the frequencies below 2000 Hz, with thresholds greater than 40 dBHL at frequencies above2000 Hz.
In addition, the doctor must provide a statement that the patient has asked for a hearing aid, and that they are “alert” and “able to utilize their aid appropriately.”
If you meet that standard, you qualify for a monaural hearing aid in the state of New York. For a binaural hearing aid, you’ll need to meet at least one of the following additional criteria:
● Professional or social needs that require binaural hearing
● You were already using binaural hearing aids before you started receiving Medicaid
● You’re legally blind, or suffer from severe enough visual impairment to impact your life
Is Miracle Ear Covered by Medicaid?
No. Medicaid covers hearing aids that have been prescribed by a medical professional in accordance with current best practices.
Miracle Ear is a hearing aid company that sells directly to consumers, without requiring a doctor’s input. For this reason, Medicare and Medicaid do not cover Miracle Ear purchases.
Depending on which Miracle Ear hearing aid you buy, the cost can average between $1,000 and $5,000. However, Medicaid recipients can apply to the Miracle Ear Foundation to receive one for free. If the application is approved, the Miracle Ear Foundation will pay 100% of the costs towards a new hearing aid.
What Is the Process for Getting Approved for a Hearing Aid From Medicaid in NY?
Medicaid approval for a hearing aid is a multi-step process. First, as we already discussed, you’ll need to visit your general practitioner, get a referral, and receive your evaluation from a specialist. At that point, if all goes well, you’ll have a prescription in hand.
Because not all hearing aids work for all people, manufacturers provide a 30-day trial period to see if the device is a good match. At this point, you’ll need to have a follow-up visit with your ENT or audiologist to see how things are going. If the hearing aid is working, you’ll be ready to submit your claim. If not, you’ll need to return the hearing aid and either try a different model or modify your approach.
To receive reimbursement, don’t skip your follow-up visit. Even if the hearing aid is working perfectly, go to that appointment. Medicaid will need to confirm with your specialist that the hearing aid is working before they provide payment.
At this point, all of your doctor’s visits and specialist visits will already have been covered. To receive reimbursement for the hearing aid itself, you’ll need to submit a receipt or an invoice. This paper must include the brand name, model, and serial number of the hearing aid in order to be accepted. If it doesn’t, you’ll need to request a corrected invoice from whoever sold you your hearing aid.