Centers for Medicare and Medicaid Services (CMS) have changed Medicare cochlear implantation candidacy requirements. These changes will allow for more coverage for individuals 65 and older to receive cochlear implants. Motivation for these changes was largely in response to a recent study that examined these requirements and their accessibility.
Access to cochlear implants has been hindered by restrictive insurance guidelines for people of all ages. Original guidelines placed by Medicare led to exclusion of individuals 65 years or older from receiving the care they needed. Previously, candidacy criteria were based on if the patient’s hearing was severe enough to qualify.
Candidacy Criteria for Insurance Coverage
According to the study, if a patient had a sentence test score of 41 percent or higher with a hearing aid, they were automatically disqualified from coverage for a cochlear implant. Intuitively speaking, hearing only 41 percent means you are still missing at least 59 percent of a sentence. Correspondingly, missing at least 59 percent of a sentence equates to hearing only four out of 10 words.
One of the authors of the study and Executive Director of the American Cochlear Implant Alliance, Donna Sorkin, stated, “This means that most people could not understand speech without having the ability to see someone’s face. People struggled to communicate. New Medicare candidacy allow someone with bilateral hearing loss to have up to 60 percent words in sentences wearing well fit hearing aids.”
“New Medicare candidacy allow someone with bilateral hearing loss to have up to 60 percent words in sentences wearing well fit hearing aids.”
Notably, this influential change would not have been possible without the American Cochlear Implant Alliance. This Alliance strives to remove the barriers for implantation. They saw the need to investigate these qualification measurements to see if they were truly appropriate. Back in 2013, a study was formed to evaluate these terms and conditions for older adults. This study was published in 2020.
The Study That Led to the Changes
This research study, “Assessment of Cochlear Implants for Adult Medicare Beneficiaries Aged 65 Years or Older Who Meet Expanded Indications of Open-Set Sentence Recognition: A Multicenter Nonrandomized Clinical Trial” was intentionally created to see if expanded criteria would prove to be beneficial. However, the formal request of the American Cochlear Implant Alliance was to see if the CMS would expand their criteria. This expansion would change the original cutoff of individuals who scored 41 percent on their sentence recognition tests to 60 percent.
This trial evaluated preoperative and postoperative benefits of 31 total patients. These individuals were aged 65 years or older. They received cochlear implants at eight different centers. In addition, they received coverage from the Centers for Medicare and Medicaid Services to enable them to participate in this program.
Participants also received a cochlear implant between September 17, 2014 until July 10, 2018. For those four years, this study looked at the effects of the cochlear implants versus hearing aid technology in a variety of settings. Sentence, word, and telephone word recognition plus quality of life were reviewed. Not surprisingly, these results showed an improvement in all these categories for the cochlear implant recipients.
Study Outcomes: A Request for Accessibility
Upon conclusion of this study, the American Cochlear Implant Alliance submitted their request to the CMS. On September 26, 2022, Medicare reviewed this case. They ultimately changed the candidacy requirements to expand insurance coverage!
Sorkin reflected, “Adults receiving CIs under Medicare typically had longer periods of deafness and less residual hearing by the time they were eligible. Not only were older adults forced to struggle more to hear and communicate for a longer period of time, outcomes could also be impacted as wait times and amount of residual of hearing at the time of CI do factor into outcomes to some degree.”
Benefit of Cochlear Implantation for Older Populations
Auditory decline can be associated with older age. Markedly, this leaves many older individuals struggling with their hearing loss. Now technology exists to aid in the person’s overall well-being. With hearing aids and cochlear implants becoming more advanced, individuals may not have to struggle to hear as much.
“We know that early auditory rehabilitation is important to people of all ages—including older adults—as it can provide benefits beyond hearing ability such as cognitive function,” Sorkin said. “There is a body of research that has shown this.”
Proper fitting of hearing technology helps impact social and mental satisfaction of individuals. This is especially true for older individuals who had full hearing and lost their hearing over time. Additionally, a recent study has shown how providing hearing technology in the older adults has been found to lower the risk of dementia.
Sorkin helped lead this positive change. “We started this important initiative as a means of equalizing access across the age continuum,” she said. “Older adults may not be able to do as much physically as they did when they were younger. But they can and should be able to engage with friends and family, attend social events, go to the theater and enjoy concerts—just as they did when they were younger. Communication is just as important to older adults!”
Abigail Russell is a second-year medical school student at Indiana University School of Medicine. She is a bilateral hearing technology user, utilizing both a Phonak Naída and Cochlear Implant. Ever since she was diagnosed as a little girl, she has been an advocate for those with hearing loss. She loves spending time with people, enjoys coffee, and cuddles with her puppy, Rosie!
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