Hearing Aid Benefit Cap & Benefits - Frequently Asked Questions for Beneficiaries
1. What is the hearing aid benefit cap?
2. What is included in hearing aid benefits?
3. Why did Medi-Cal create the hearing aid benefit cap?
4. When did the cap take effect?
5. Can I still get two hearing aids for $1,510?
6. What happens if my hearing aids cost more than $1,510?
7. Does the hearing aid benefit cap apply to everyone?
8. I think I might qualify for hearing aids. Will Medi-Cal pay when I get screened for hearing loss?
9. Can I get replacement batteries for my hearing aid?
10. Will Medi-Cal pay to have my hearing aids repaired?
11. My hearing aids need new parts. Can I still have my hearing aids parts replaced?
12. Can I get new hearing aids if mine are lost, stolen, or damaged?
13. Can I have my hearing aids tested to make sure they are working?
14. Does Medi-Cal cover a cochlear implant?
15. I had a cochlear implant and need someone to examine my hearing at regular intervals. Can I still get a hearing screening to test my
cochlear implant?
16. Are bone anchor hearing aids (BAHA) subject to the cap?
17. Will Medi-Cal test my BAHA to make sure it is working properly?
1. What is the hearing aid benefit cap?
Answer: Medi-Cal will pay up to $1,510 per person each fiscal year (between July 1 and June 30) for hearing aid benefits, including hearing aids, except for those beneficiaries who fall under the exemptions because they are not subject to the hearing aid benefit cap. See Question No. 7 for a list of who is exempted from the benefit cap.
2. What is included in hearing aid benefits?
Answer: Hearing aid benefits include hearing aids; molds, supplies, and inserts; repairs; an initial set of batteries; six visits for training, adjustments, and fitting with the same vendor after the beneficiary receives the hearing aid; and rental. See Question No. 8 for information on hearing screenings.
3. Why did Medi-Cal create the hearing aid benefit cap?
Answer: The cap was approved as part of the Budget Act of 2011. The Act cut $10.8 billion from the state budget to reduce California’s projected $26.6 billion budget shortfall for the 2011-012 fiscal year.
4. When did the cap take effect?
Answer: Medi-Cal implemented the cap on July 1, 2012.
5. Can I still get two hearing aids for $1,510?
Answer: Yes. The $1,510 cap will allow you to receive two analog hearing aids in the same year. This includes initial batteries, molds, and six visits with the same provider for fitting and adjustments after you receive your hearing aids. Digital hearing aids are more expensive, so you might not be able to get two in the same year. Talk to your hearing aid vendor about options available to you. Also see Question No. 6 for more information on what is covered by this cap.
6. What happens if my hearing aids cost more than $1,510?
Answer: By law, vendors may not bill you if they accept Medi-Cal payment for the same service. For example, the vendor is not allowed to sell you hearing aids that sell for $2,010 by billing Medi-Cal for $1,510 and billing you $500 for the difference. Medi-Cal will not pay more than $1,510 for hearing aid benefits for the same person in the same fiscal year, except for those beneficiaries who fall under the exemptions. See Question No. 7 for a list of who is exempted from this cap. If you reach the cap during the year and then have additional expenses above $1,510 during the same fiscal year, Medi-Cal will deny payment. A new allowance of $1,510 is available to each person on July 1 each year.
7. Does the hearing aid benefit cap apply to everyone?
Answer: No. By law, the following Medi-Cal eligible beneficiaries are not subject to the hearing aid benefit cap:
• Pregnant women if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.
• Beneficiaries who are younger than age 21 and receive full-scope Medi-Cal.
In addition, hearing aids that are lost, stolen, or irreparably damaged beyond your control are not subject to the cap, although you will need to follow certain steps to receive a replacement hearing aid. See answer to Question No. 12 for what you need to do if your hearing aids are lost, stolen, or irreparably damaged.
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8. I think I might qualify for hearing aids. Will Medi-Cal pay when I get screened for hearing loss?
Answer: Medi-Cal does not pay for hearing screenings except for the following people:
• Pregnant women if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.
• Children or young adults who are younger than age 21 and receive full-scope Medi-Cal.
• People who live in a licensed nursing home such as a skilled nursing facility (SNF), intermediate care facility (ICF), ICF for the developmentally disabled (ICF-DD) and subacute care unit.
9. Can I get replacement batteries for my hearing aid?
Answer: Medi-Cal will only pay for replacement hearing aid batteries for beneficiaries who are younger than age 21. Medi-Cal does not pay for replacement hearing aid batteries for adults. Everyone should receive one standard battery packet with their new hearing aid(s).
10. Will Medi-Cal pay to have my hearing aids repaired?
Answer: Yes. Medi-Cal pays for hearing aid repairs when the cost is within the annual cap. However, Medi-Cal does not pay to see if the hearing aid is working.
11. My hearing aids need new parts. Can I still have my hearing aids parts replaced?
Answer: Yes. Medi-Cal will pay to have hearing aid parts replaced when the cost is within the annual cap.
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12. Can I get new hearing aids if mine are lost, stolen, or damaged?
Answer: Yes. Hearing aids to replace ones that were lost, stolen, or irreparably damaged beyond your control are not subject to the cap. However, you need to meet certain requirements in order to receive replacement hearing aids if the cost exceeds the annual limit. This includes providing a detailed description signed by your physician of the events leading to the damage; obtaining a completed audiometric report if your previous hearing aids were more than three months old; and providing a copy of a police report if the hearing aids were stolen.
13. Can I have my hearing aids tested to make sure they are working?
Answer: In most cases no. Medi-Cal only pays for testing for hearing aids for the following persons:
• Pregnant women if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.
• Beneficiaries who are younger than age 21 and receive full-scope Medi-Cal.
14. Does Medi-Cal cover a cochlear impant?
Answer. Yes. Medi-Cal covers Medi-Cal beneficiaries for a cochlear implant if they meet specific criteria.
15. I had a cochlear implant and need someone to examine my hearing at regular intervals. Can I still get a hearing screening to test my cochlear implant?
Answer: Yes. Medi-Cal pays for the testing, screening, or follow-up for your cochlear implant, but limits services to cochlear implant care and follow-up. These services do not count toward the cap. Medi-Cal does not pay for other services not related to cochlear implant care and follow-up services.
16. Are bone anchor hearing aids (BAHA) subject to the cap?
Answer: No. Medi-Cal considers BAHA a prosthetic device, so it is not subject to the cap.
17. Will Medi-Cal test my BAHA to make sure it is working properly?
Answer: Medi-Cal will only pay for a hearing screening for BAHA for the following persons:
• Pregnant women if it is part of their pregnancy-related care or for services to treat a condition that may cause problems in pregnancy.
• Beneficiaries who are younger than age 21 and receive full-scope Medi-Cal.
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