Medicare Coverage Question

[Shirsee]

Does anyone know if Medicare will cover one CI if the other ear has a moderate loss. I am profoundly deaf in one ear and have a moderate loss in the other with about 80% word recognition in that better ear. Thanks.

 

[tjwarney]

Yes they will pay for just the one side.

 

[EdgarOlson]

Yes, The Medicare will cover your hearing problem. I have read online that the Medicare advantage Part C plan will cover the hearing loss problem. If you are on Medicare then you will take the benefit of Medicare advantage part C plan to get the benefit of extra coverage. One can also check online for different Medicare advantage part C coverage and its benefit.

[Mary Featherston]

My aunt went through the whole process, got approved at Mayo and was then turned down by Medicare.  I am not clear on why - possibly just because her other ear's hearing loss wasn't profound enough.  But I would be careful about saying yes in all cases.

[Hal in Maryland]

I received my first implant (Medel SONATA) Left ear in 2009. I currently use the Sonnet processor. I am using a BTE aid in my Right ear. I believe I am a good candidate for a CI in my Right ear as well. My question is, "Will Medicare pay for the 2nd CI?" For reference, I am attaching my latest audiogram.

I'd be happy to hear of anyone's experience getting a bilateral CI paid for by Medicare. Thank you.

Audiogram Jun 4 2020.pdf

[Mary Beth]

@Hal in Maryland

I will tag @Joan because she has a very interesting story about Medicare and bilateral CIs!

[Hal in Maryland]

Thank you Mary Beth. Anxious to hear @Joan's story.

As you see from my audiogram, I get very little from my Right ear.

[Mary Beth]

@Hal in Maryland

Your audiogram says UNAVAILABLE.  I find posting pics of documents works better in this forum for some reason.

[Dave in Pittsburgh]

I am on Medicare I am also bilateral Medicare paid for my first implant in 2016 and also paid for the second implant in 2018 no questions ask no problem 

[Hal in Maryland]

I ask because my CI Audiologist says there's no guarantee that Medicare will pay so if they don't I get a big bill.

Thanks for your response.

[Dave in Pittsburgh]

Well I don’t know how it works with your CI center you got the approval or rejection well before surgery also they said if it was rejected would appeal 

[Joan]

@Hal in Maryland as @Mary Beth mentioned, my experience with Medicare was an interesting one. Admittedly, I don’t know what Medicare decisions regarding CI implants are based on (aside from a candidate meeting their audiology requirements for eligibility), but I was fortunate that both of mine were covered.
 

Very soon after my initial implant (covered by Medicare) in 2014, I queried my audiologist about getting my other ear implanted (both ears had been previously tested and both were eligible based on Medicare requirements of hearing loss). I was told that, to their knowledge, Medicare would cover only one implant, except in extenuating medical circumstances (which I did not have). Medicare did not “pre-approve” coverage of the implants and there would be no guarantee my second implant would be covered, so if I were to get a second implant I would have to first sign a guarantee I would pay all costs if Medicare didn’t. Those costs weren’t  something I would be able to cover, should the need arise. However, at a follow up appointment shortly after that discussion, my audiologist said the clinic had decided to ”test the waters” on that issue with Medicare (at the clinic’s expense if Medicare denied coverage). I was offered the opportunity to be their “test” case, their first Medicare patient to receive a second implant. Of course I jumped at that chance! And, as it turned out, Medicare did cover the cost of my second implant. 
 

Please understand that this was just my (very fortunate) experience and I have no way of knowing how any other individual’s situation would be handled. I wish you good luck in pursuing your second implant and certainly hope it is approved!

[Hal in Maryland]

Thank you. I’m not planning to do anything until Covid19 is better under control.

Thank you for sharing your story. 

[Joan]

@Hal in Maryland that’s a good decision! Keep us posted on how things turn out for you. Good luck!

[Hal in Maryland]

Hi Joan and Mary Beth. I decided to go ahead with a second implant. I'm hope binaural hearing will make my life easier. I have an appointment with the surgeon at Johns Hopkins in Baltimore on Thursday. 

I'm still using a BTE HA in my right ear even though on the aided sentence comprehension test with CI off, I scored zero. I think it's time!  Re: Medicare paying... My first CI was before my 65th birthday (12 years ago), so Medicare was not the payer. I hope that will help.

I was reading up on the Sonnet 2's features. I hope to be able to use the phone with audio link.

Thanks for listening

[Joan]

@Hal in Maryland I think you’ll be very happy with your decision and will be wonderfully surprised with bilateral CI hearing!  Since this will be your first implant under Medicare, I don’t think coverage should be an issue. Thanks for letting us know about your plan. Do keep us posted!

Good luck at Thursday’s appointment.

[Hal in Maryland]

Thank you for your encouragement! I'll keep you and@Mary Bethposted.

[Dave in Pittsburgh]

I am bilateral I’m on Medicare I had my first implant in 2016 second 2018 Medicare approved both operations no questions ask.

So good luck

[Hal in Maryland]

My first CI was implanted in 2009. I’m ready to try binaural hearing. Thanks @Dave in Pittsburgh for your support. 

[Hal in Maryland]

Thank you to all @Mary Beth @Joan @Dave in Pittsburgh and others who responded to me re: 2nd implant.  I met with the surgeon at Johns Hopkins in Baltimore and I decided to proceed with CI for my Right ear. I expect to have the surgery at the end of August or sometime in September. 

In the meanwhile, I downloaded the "AudioKey 2" App to my iPhone and signed up with "my-medel". I have not been successful pairing the app to my Sonnet processor. My guess is that my 5-year old Sonnet is too old and may not have BT features. Perhaps I'm just jumping the gun. Any thoughts?

Thanks.  Hal

[Joan]

@Hal in Maryland a great decision! Hoping your surgery is sooner rather than later.😊 Since I don’t have Sonnets, your AudioKey question is one for @Mary Beth. I’m sure you’ll hear from her soon. Keep us posted on your surgery date. Best of luck!

[Hal in Maryland]

Thank you @Joan for your response. Timing for surgery is not logistically simple as I am the main caregiver for my disabled wife (spinal cord injury). I will need transportation to Hopkins since my wife cannot drive and I won't be allowed to drive home from surgery. We have friends who have offered to drive.

Re: Medicare, I had to sign a guarantee that I will pay if Medicare does not. I added "up to the amount that Medicare is expected to pay". Hopefully, this will not be an issue.

[Mary Beth]

@Hal in Maryland

congratulations on scheduling your surgery.

Sonnet 1 can use AudioKey 2 as a remote IF it connects to it through the AudioLink intermediary device and if our audiologists set it up to use AudioKey 2 as a remote instead of the FineTuner remote.  I chose to keep my Sonnet 1 processors using the FineTuner remote. 

[Hal in Maryland]

@Mary Beth, Thank you for clarifying. I assume my Sonnet is really a Sonnet 1. I upgraded to the Sonnet from the Opus 2 about 5 years ago. When I get my 2nd CI, the package should come with 2 processors. I will get two Sonnet 2 processors and use one R and one L. Should also come with AudioLink.

[Mary Beth]

 

@Hal in Maryland

 

Sonnet 2 can use AudioStream battery cover BTLE receivers to connect directly to phones without needing to go through AudioLink.

Sonnet 2 can also use AudioLink.