Does Medicare pay for Processor upgrades after 5 years?

[Artsy]

Sorry, I could not find a post on the forum that addresses this, though some people must have asked before.

Someone recently told me that Medicare pays for processor upgrades, typically after 5 years.

This September will be 5 years from my first implant. March will be the fifth anniversary of my having bilateral implants. I have Sonnets (not Sonnet II). Having just received a letter from Medel informing me that the warranty on the first processor will expire this year, I was wondering whether upgrading to new processors would be covered next March.

Also while on the topic, is there any talk of a new processor that will supersede the Sonnet II in the foreseeable future?

 

Thanks.

[John F]

No information on any products currently and yes, they do although it may warrant a call to them to make sure.

[Mary Beth]

@Artsy

@Joan has experience with Medicare upgrades 

[Joan]

@Artsy yes, Medicare (together with my supplemental insurance) covered my bilateral upgrade three years ago. It was handled by Med-El, but I believe the process required my audiologist needed to complete a form for Med-El stating the need/benefit of my being upgraded. To my knowledge, only the fact a processor is out of warranty is not sufficient reason for an upgrade.

[Artsy]

Thank you all!

[Mary Featherston]

On 8/16/2022 at 2:48 PM, Joan said:

@Artsy yes, Medicare (together with my supplemental insurance) covered my bilateral upgrade three years ago. It was handled by Med-El, but I believe the process required my audiologist needed to complete a form for Med-El stating the need/benefit of my being upgraded. To my knowledge, only the fact a processor is out of warranty is not sufficient reason for an upgrade.

@Joan what other factors do they consider?  Did you get any detail?  I'm planning to retire in the spring, and will not have had both CIs for five years yet at that point.

[Joan]

@Mary Featherston upgrades are not an option until your processor(s) is past the five year mark, no matter your insurance. As far as I know, once that criteria has been met, the audiologist’s statement of need/benefit  is the only other requirement Medicare has, but you might check with your CSR to verify that.
Med-El handles the transaction with Medicare. You can start the upgrade process with Med-El shortly before your five year mark.

[Mary Beth]

@Mary Featherston

Some non-Medicare health insurance plans have very strict criteria for upgrades.  Processors have to be unable to be repaired.  It varies by plan.

 

[Mary Featherston]

7 hours ago, Mary Beth said:

@Mary Featherston

Some non-Medicare health insurance plans have very strict criteria for upgrades.  Processors have to be unable to be repaired.  It varies by plan.

 

I'd be surprised if that were so for my health insurance through work.  When I initially was going to be implanted I wanted to be sure that it was covered (my husband suggested doing it regardless but it is in fact a lot of money).  My insurance company -- well, suffice it to say that the worst part was talking to 485 people before I got to someone who could answer.  Her response was, "oh, you don't have to get approval for that, just get it done and we'll get the bill".

3M does OK by us.  🙂  But when my aunt applied for CIs with Medicare they turned her down as not having bad enough hearing, so I'm guessing that somewhere, if you can just find them, there are documented rules.

Still, it's not a huge worry.  I actually have three sets of perfectly good processors, thanks to the Rondo 2 deal.

[Mary Featherston]

10 hours ago, Joan said:

@Mary Featherston upgrades are not an option until your processor(s) is past the five year mark, no matter your insurance. As far as I know, once that criteria has been met, the audiologist’s statement of need/benefit  is the only other requirement Medicare has, but you might check with your CSR to verify that.
Med-El handles the transaction with Medicare. You can start the upgrade process with Med-El shortly before your five year mark.

Thanks, Joan!  My five-year anniversary comes up a year from now, at which point I'll be retired and on Medicare. 

[Mary Beth]

@Mary Featherston

Medicare is known to have more strict qualifying rules for being implanted BUT organizations have been working hard to try to change that and there is something being considered now that would be qualifying for a CI through Medicare (at least for one ear) more in line with commercial insurance.

https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=245

[Mary Beth]

@Mary Featherston

Here is info on Medicare and replacement of processors

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=53708

 

 

[Mary Featherston]

Thanks, @Mary Beth- so basically, it's up to the doctor/audiologist.  I suspect they left it somewhat vague deliberately.

[Mary Featherston]

The nice thing for us, too, is that most of the cost is the surgery and implants.  The processors are expensive but not entirely out of reach.

[Mary Beth]

@Mary Featherston

The audiologist submits justification and the Medicare end of 5 year useful life seems to seal the deal.  I am told replacing processors tends to go smoothly under Medicare.

I remember @Joan’s process went quite quickly.

[Joan]

@Mary Featherston  @Mary Beth  yes, my process went extremely smoothly. I was told by my CSR that some, but not all, Medicare supplemental insurances won’t allow the upgrade process to even start until after the five year mark. I was fortunate that was not the case with my supplemental coverage. However, in any case, the upgraded processors cannot be issued by Med-El to the user prior to the five year mark. I received mine very soon after my five year date.

[Dianna]

13 hours ago, Joan said:

@Mary Featherston upgrades are not an option until your processor(s) is past the five year mark, no matter your insurance. As far as I know, once that criteria has been met, the audiologist’s statement of need/benefit  is the only other requirement Medicare has, but you might check with your CSR to verify that.
Med-El handles the transaction with Medicare. You can start the upgrade process with Med-El shortly before your five year mark.

Thank you for this

[Dianna]

I retired in between my 64 and 65th bday. I had started ss. I obtained insurance from the marketplace based on my income from social security, so i also had whats called "extra help" not full medicaid. In my state, medicaid is state paid. 

I paid nothing for my appointments and ci.

Now a year later i have ss medical, an advantage plan, apparently with extra help again and i paid nothing for a hearing aid! My insurance does not cover hearing aids, so i was pleasantly surprised i didnt have to use savings and a credit card to get the aid.

So i think it all depends on social security advantage plan coverage, plus what state you reside in.

We all received extra benefits due to covid, and now biden is trying to give seniors and disabled folks more, it will be interesting.

Personally i will have to be on the lookout for benefits and carriers before my 5 year anniversary barring any blooming issues before then.

The medel folks know how to bill, the docs office know how to bill, if you get a good medical insurance "biller" who knows what to do you are fortunate.

[Dianna]

While im thinking about it, does anyone have experience getting ci approved after your insurance has paid for a hearing aid? My last pair crapped out at 3 years.

[Mary Beth]

@Mary Featherston

One of the things I am taking into consideration regarding the timing of upgrading processors (in addition to the insurance rules) is how long the present processor has been available.

Sonnet 2 released elsewhere Fall 2019 with ASM 3 active, in US released January 2020 without ASM 3

Sonnet 2 ASM 3 FDA approved June 2021, released August 2021
 

Med-El released Sonnet 2 in Europe in 2019.  It’s anybody’s guess when the next BTE processor will be released.  
 

There is never advance notice.

Will it be 5 years after Sonnet2?? That would be in 2024.  When would it release in the US?  Would all its new features be active right away in the US?  That has not been the case for Sonnet2. Sonnet1 nor Rondo 2.  In the US Med-El released new processors but we had long waits for their new features to be available here pending FDA approval.  Do we want to use up part of our 3 year warranty while waiting for the new features to be released here?

Lots to consider.

I was implanted 7.5 years ago and have not chosen to upgrade yet.

[Mary Featherston]

43 minutes ago, Mary Beth said:

@Mary Featherston

One of the things I am taking into consideration regarding the timing of upgrading processors (in addition to the insurance rules) is how long the present processor has been available.

Sonnet 2 released elsewhere Fall 2019 with ASM 3 active, in US released January 2020 without ASM 3

Sonnet 2 ASM 3 FDA approved June 2021, released August 2021
 

Med-El released Sonnet 2 in Europe in 2019.  It’s anybody’s guess when the next BTE processor will be released.  
 

There is never advance notice.

Will it be 5 years after Sonnet2?? That would be in 2024.  When would it release in the US?  Would all its new features be active right away in the US?  That has not been the case for Sonnet2. Sonnet1 nor Rondo 2.  In the US Med-El released new processors but we had long waits for their new features to be available here pending FDA approval.  Do we want to use up part of our 3 year warranty while waiting for the new features to be released here?

Lots to consider.

I was implanted 7.5 years ago and have not chosen to upgrade yet.

@Mary Beth yes, I was thinking of that.  I'm actually perfectly happy with my Sonnets and Rondo2s, so if I got an upgrade I'd get Sonnet 2s, or maybe Rondo3.  I got to wear Sonnet 2s when I was participating in research in Durham, and they were really nice.  But if I got Rondo 3s I'd get two mics AND nothing behind my ear.

Or, like you, I could just wait and see.  🙂

[Dianna]

Well we have new super rechargable batteries and when will they be fda approved in the us?

It appears to me that medel is doing a ton of advertising about sonnet2 eas right? All of this music appreciation! 

And, low energy bluetooth!

 So maybe they will just improve on what we have.

[Serena Metzler]

I don't know because that is r good question to ask your Surgeon 😷 who did the Surgery

[Dianna]

On 9/17/2022 at 6:53 PM, Mary Featherston said:

@Mary Beth yes, I was thinking of that.  I'm actually perfectly happy with my Sonnets and Rondo2s, so if I got an upgrade I'd get Sonnet 2s, or maybe Rondo3.  I got to wear Sonnet 2s when I was participating in research in Durham, and they were really nice.  But if I got Rondo 3s I'd get two mics AND nothing behind my ear.

Or, like you, I could just wait and see.  🙂

I have only sonnet2eas, and i believe the research im in is for sonnet2eas and aging. But i really wish i could have tried rondo 3 also, but im so happy right now dont want to be greedy. If i win the lottery hahaha first thing id get is a rondo to try.

It would be nice to have the rondo for outdoor treks, but then i would be afraid of losing it, the sonnet2 with eas plug is soooo secure.

Its strange to me that the rechargeable batteries are kind of large compared to two disposables but the rechargables need more tech.

If the tech was moving along bt capability to the processor, then the big battery max would be all we need. Which is what im guessing.

So with me and mine, i guess i have the latest technology...happy for now. 

I received my implant kind of based on ssd, however both sides were on the fence between moderate to severe. Now, if i were tested i would be severe on the ci side because of the implant reducing part of the residual hearing.

So for now i can hear out of non implanted ear but probably qualify for ci when it wears out. When i do, my hope is a rondo-like device with bt no loop.

[Mary Featherston]

@Dianna I am currently trying out the new max batteries.  They're longer than the standard rechargeables but once I have the processors on my ears I can't tell the difference - they probably are a bit heavier than the regular batteries but it's not discernable to me.