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Health Insurance DOES Cover Cochlear Implants, in partnership with American Cochlear Implant Alliance

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1.  Which of the following types of insurance is a federally based program that provides coverage for appropriate patients 65 years of age and older: Medicaid Blue Cross/Blue Shield Medicare Affordable Care Act Plans

2.  Medicare eligibility for cochlear implants: Is the same as that for patients covered by private health insurance. Is strictly limited to patients with an appropriate hearing profile who are 65 years of age or older. Requires that the individual meet income limitations. Requires candidacy based upon specific Medicare hearing candidacy rules and is not pre-authorized.

3.  Patients who have straight Medicare insurance as well as a Medicare supplement plan typically have which of the following out of pocket expenses related to a cochlear implant: Patients will be responsible for paying for approximately 20% of the procedure. Patients will be responsible for paying for approximately 50% of the procedure. Patients will typically not have any out-of-pocket expenses related to the procedure. Patients will not know in advance what their out-of-pocket expense will be.

4.  Insurers will pay for a sound processor upgrade when: The processor has been in use for more than five years. The processor is out of warranty. The processor is broken. This differs among insurance companies and needs to be determined for the individual insurer and patient.

5.  The process of gaining coverage for a cochlear implant processor upgrade requires: That the implant center and/or surgeon provide a letter indicating the upgrade is medically necessary before they will authorize payment for the upgrade. That the recipient demonstrate poor speech perception with their existing technology. A simple request for reimbursement since the patient already has a CI. A statement that the individual will not need another upgrade for at least five years.

6.  Which of the following options are available if a patient’s insurer does not cover cochlear implant surgery and follow-up care? The patient may consider switching to a different insurer. If an adult, the patient may consider applying for supplemental security income (SSI) as this may enable him/her to receive enrollment in Medicaid or Medicare. If a child, the parents may explore whether their state covers children with disabilities under Medicaid regardless of family income. All of the above

7.  Which of the following is a federal/state insurance plan that provides health coverage for persons with very low income: Medicare Medicaid HAP Affordable Care Act Marketplace Plans

8.  The major difference between coverage of cochlear implants for adults and children under private health care plans is: The amount of allowable reimbursement is higher for children. Auditory therapy after the surgery is typically covered for children but not for adults. There are no systematic differences in coverage by age under private health care plans. Getting a processor upgrade reimbursed from private insurance is generally easier for a pediatric CI recipient.

9.  Medicaid plans cover cochlear implants and related services: For eligible children throughout the US and for eligible adults in about 2/3 of states. For eligible children and adults in all 50 states. Only if the individual has no residual hearing at any frequency. Only for the initial surgery and device but not for the aftercare.

10.  Once someone gets a cochlear implant, (s)he may expect that his/her hearing aid on the contralateral ear will also be covered by health insurance: Depending upon his/her insurance and also by the age of the individual some insurance types may cover. Nearly always because of the investment the insurer has made in the CI device. Depending upon the recommendation of the audiologist. Depending upon the person’s hearing profile