Hearing exams and hearing aids, Medicare

Applies to:

Priority Health Medicare Advantage plans

Definition

Priority Health Medicare Advantage members may add the OPTIONAL Enhanced Vision, Dental and Hearing package to their coverage when they enroll.

The optional hearing coverage in the package, Priority Health Hearing, is administered by Priority Health Medicare.

Check for eligibility

To verify that the member is enrolled in Priority Health Hearing, check the Member Inquiry tool under supplemental benefits or call the Priority Health Medicare Customer Service Department at 888.389.6648, Monday through Friday from 9 a.m. to 8 p.m.

Covered benefits

Coverage runs from Jan. 1 through Dec. 31 of each calendar year, the same as the member's Medicare Advantage plan.

Members can use their in-network benefit or their out-of-network benefit, but not both.

In-network benefit:

  • Hearing exam: $0 copay
  • Hearing aid: $500 per ear, $1,000 max every 24 months

Out-of-network benefit:

  • Hearing exam: Up to $25
  • Hearing aid: $500 per ear, $1,000 max every 60 months

No remaining balance

The benefit is exhausted once a member has received two hearing aids. No remaining hearing aid "balance" is available should they use less than the maximum benefit allowed per ear or less than the maximum for two hearing aids in a 60-month period.

For details, check the member Priority Health Medicare Certificate.

Medicare hearing benefits billing

Participating providers:

A participating provider is a provider who is contracted with Priority Health Medicare.

Submit claims directly to Priority Health Medicare for payment.

Priority Health Medicare will bill the member for any charges in excess of their benefit coverage amount. The member is responsible for incurred charges after plan allowances and discounts as outlined in the Hearing benefits found in the member certificate.

Non-participating providers:

Collect your fee from the member in full at time of service and complete your portion of the out-of-network claims form that the member is required to submit for reimbursement.

Members then complete and sign the out-of-network claim form for reimbursement of up to $25 for an exam and $500 per hearing aid, up to $1,000 max, and submit the form and paid receipts to:

Priority Health
Attn: Claims
1231 East Beltline NE
Grand Rapids, MI 49525