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Bessen SY, Garcia Morales EE, Lin FR, Reed NS. Use of Hearing Services in Traditional Medicare and Medicare Advantage. JAMA Health Forum. 2024;5(10):e243619. doi:10.1001/jamahealthforum.2024.3619
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Research Letter
October25, 2024
Sarah Y.Bessen,MD, MPH1,2; Emmanuel E.Garcia Morales,PhD1,3; Frank R.Lin,MD, PhD1,2; et al Nicholas S.Reed,AuD, PhD1,4
Author Affiliations Article Information
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1Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, Maryland
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2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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4Optimal Aging Institute, NYU Grossman School of Medicine, New York, New York
JAMA Health Forum. 2024;5(10):e243619. doi:10.1001/jamahealthforum.2024.3619
Introduction
Hearing aids and most related hearing services are statutory exclusions under traditional Medicare (TM), requiring beneficiaries to face high out-of-pocket costs or navigate a complex network of Medicare Advantage (MA) plans for coverage. Nearly 90% of Medicare beneficiaries who report difficulty hearing do not own hearing aids.1 Our aim was to compare MA and TM beneficiaries’ use of hearing evaluations and hearing services.
This cross-sectional analysis pooled the 2019-2021 cycles of the Medicare Current Beneficiary Survey (MCBS), a nationally representative panel survey of the Medicare population. The MCBS is approved by the NORC at the University of Chicago institutional review board, which waived informed consent due to use of publicly available, deidentified data. The study followed the STROBE reporting guideline.
We grouped adult beneficiaries (aged ≥65 years) into 5 mutually exclusive categories based on presence of additional coverage: TM only, Medicaid, employer sponsored, MA, and Medigap. Use of hearing services (routine hearing examinations, hearing aid fittings, purchase of hearing aids) within the past year was derived from the Hearing Utilization Events survey. These measures are described more fully in eMethods 1 to 3 in Supplement 1). For participants with responses in multiple survey cycles, only the most recent responses were considered.
We estimated percentages using multivariable logistic regression adjusted for demographic (age and self-reported sex and race and ethnicity [Asian, Black, Hispanic, White, other (including American Indian or Alaska Native, Native Hawaiian or Pacific Islander, more than 1 race or ethnicity, or other not otherwise specified)] derived from the MCBS), socioeconomic, and health characteristics (eMethods 4 in Supplement 1) to assess the association between insurance type and hearing services use. A sensitivity analysis was restricted to participants with self-reported hearing loss or hearing aid use. Survey weights were used to account for the complex MCBS design. Analyses were performed between March 28 and July 20, 2024, using Stata, version 18.0 (StataCorp LLC).
Results
In a sample of 19 818 MCBS participants (mean [SD] age, 77.0 [7.3] years; 55.4% female, 44.6% male), a weighted 48.7% reported hearing loss or hearing aid use (Table 1). Compared with beneficiaries with only TM (10.9%), MA beneficiaries (28.6%) had similar estimated adjusted percentages of hearing service use, including routine hearing tests (TM, 4.2% [95% CI, 3.3%-5.1%]; MA, 5.3% [95% CI, 4.8%-5.9%]), hearing aid fittings (TM, 3.2% [95% CI, 2.4%-4.0%]; MA, 3.6% [95% CI, 3.1%-4.1%]), and hearing aid purchases (TM, 2.1% [95% CI, 1.5%-2.7%]; MA, 2.4% [95% CI, 2.0%-2.9%]) (Table 2). The sensitivity analysis limited to beneficiaries with self-reported hearing loss or hearing aid use had greater use of routine hearing examinations in MA (TM, 7.1% [95% CI, 5.5%-8.7%]; MA, 9.9% [8.9%-10.9%]).
Discussion
In this cross-sectional study, Medicare beneficiaries with MA plans and TM used hearing services at similar rates overall, but MA beneficiaries with hearing loss or hearing aid use were more likely to receive hearing examinations. Further research is needed to better understand the use of hearing services in MA and other categories of Medicare coverage.
The broader literature shows mixed quality benefits of MA compared with TM, though recent work estimated that Medicare spent 6% more on MA enrollees compared with similar TM enrollees in 2023.2 Our findings are consistent with research suggesting similar use of dental and vision services (also excluded from TM) between MA and TM beneficiaries.3,4
While nearly all MA enrollees have access to hearing benefits, including 97% in 2021, the observed similar use rates between TM and MA beneficiaries may correlate with widespread variation in generosity or beneficiary awareness of MA plan benefits.5 A limitation of our study was the inability to assess heterogeneity of hearing care benefits across MA plans. Further research, including review of individual plan benefits, is needed to understand how specific MA plan features correlate with use of hearing services among Medicare beneficiaries with hearing loss.
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Article Information
Accepted for Publication: August 24, 2024.
Published: October 25, 2024. doi:10.1001/jamahealthforum.2024.3619
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Bessen SY et al. JAMA Health Forum.
Corresponding Author: Sarah Y. Bessen, MD, MPH, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, 601 N Caroline St, Baltimore, MD 21287 (sbessen2@jh.edu).
Author Contributions: Dr Bessen had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Bessen, Garcia Morales, Reed.
Drafting of the manuscript: Bessen.
Critical review of the manuscript for important intellectual content: All authors.
Statistical analysis: Bessen, Garcia Morales.
Obtained funding: Lin.
Supervision: Reed.
Conflict of Interest Disclosures: Dr Lin reported receiving consultant fees from Apple and Frequency Therapeutics outside the submitted work and being the director of a public health research center funded in part by a philanthropic donation from Cochlear Ltd to the Johns Hopkins Bloomberg School of Public Health. Dr Reed reported being a former Neosensory scientific advisory board member (2021-2023). No other disclosures were reported.
Funding/Support: This work was supported by grants from the National Institute on Aging (U01AG32947 and K23AG065443; Dr Reed) and the National Institute on Deafness and Other Communication Disorders (5T32DC000027-27; Dr Bessen).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2.
References
Willink A, Assi L, Nieman C, McMahon C, Lin FR, Reed NS. Alternative pathways for hearing care may address disparities in access. Front Digit Health. 2021;3:740323. doi:10.3389/fdgth.2021.740323PubMedGoogle ScholarCrossref
The Medicare Advantage Program: status report. Medicare Payment Advisory Commission. Published March 2023. Accessed August 15, 2024. https://www.medpac.gov/wp-content/uploads/2023/03/Ch11_Mar23_MedPAC_Report_To_Congress_SEC.pdf
Simon L, Cai C. Dental use and spending in Medicare Advantage and traditional Medicare, 2010-2021. JAMA Netw Open. 2024;7(2):e240401. doi:10.1001/jamanetworkopen.2024.0401PubMedGoogle ScholarCrossref
Aggarwal R, Gondi S, Wadhera RK. Comparison of Medicare Advantage vs traditional Medicare for health care access, affordability, and use of preventive services among adults with low income. JAMA Netw Open. 2022;5(6):e2215227. doi:10.1001/jamanetworkopen.2022.15227PubMedGoogle ScholarCrossref
Freed M, Cubanski J, Sroczynski N, Ochieng N, Neuman T. Dental, hearing, and vision costs and coverage among Medicare beneficiaries in traditional Medicare and Medicare Advantage. Kaiser Family Foundation; 2021. Accessed August 15, 2024. https://www.kff.org/health-costs/issue-brief/dental-hearing-and-vision-costs-and-coverage-among-medicare-beneficiaries-in-traditional-medicare-and-medicare-advantage/