What is the difference between hearing aids from the private market and devices that are reimbursed?
If you are looking for hearing aids, you will soon come across the terms “within healthcare” and “outside healthcare”. But what exactly does that mean? And how much compensation can you expect? I will explain that to you in detail in this blog!
Two Segments
To begin with, you can simply divide hearing aids into two segments. Healthcare appliances (which are therefore reimbursed) and private appliances (outside category / private market). This is also sometimes translated into indoor and outdoor healthcare hearing aids or healthcare and private devices. The difference between these two segments is in the compensation that is given for them. In many cases, nothing is reimbursed by the health insurer in the outside category. Later in this blog I will explain why, but let’s first start with an explanation of the devices within healthcare.
A hearing aid within healthcare
A new compensation system has been in force since 2013. Under the basic health insurance, everyone is therefore entitled to reimbursement of up to 75% for hearing aids if they have a loss of at least 35dB. If you have taken a hearing test, the hearing care professional can immediately tell you whether or not you are eligible for this reimbursement. It is also possible to qualify for this reimbursement if you are under 18 or have received a prescription from an audiology center or ENT specialist. If you have additional insurance, you can get more than the usual 75% reimbursement. Ask your health insurer about this.
Pay attention! Your deductible also comes into play here. Usually that is € 385.
After a hearing loss has been established, you will be assigned to a category. This is done on the basis of the Amsterdam Questionnaire (AVL). This questionnaire gives an idea of how badly the hearing loss is getting in your way personally. There are 5 categories in which category 1 is the least complex hearing loss and category 5 the most complex hearing loss. Per category, devices have been selected that match the hearing problems in this category. This also contains many private brands of the large chains. These are generally the somewhat earlier developed and simpler hearing aids if we compare this with what is available outside of healthcare. And now comes the important thing: once you have been assigned a category, you can only have devices measured from this category. If you choose to buy a hearing aid from a higher category, your reimbursement will in many cases expire.
In many cases, the devices within your designated category will be adequate to help you with your hearing loss. However, we often see that people are not helped enough with devices from their assigned category. Especially in complex situations such as at meetings or in restaurants. In such cases, people can choose to go up one category or buy a hearing aid outside of the categories.
A hearing aid outside of healthcare
We often see that there are people who have not been helped with devices from their assigned category. Especially when understanding speech in noisy situations, it is not possible for people who use the simple hearing aids to do this without a lot of effort. The hearing aids outside of healthcare are often sufficient. This is because the devices contain the very latest and best hearing aids outside of healthcare.
An example is the latest series from Widex. The Widex Moment is the most advanced Widex hearing aid ever. It has the most natural sound ever. In order to also be able to offer a hearing aid within healthcare, Widex has also launched a Widex Enjoy. This device has various functionalities less and an outdated other chip. The Widex Moment has a very fast chip, for example to prevent tinny noise. The Widex Enjoy has a different chip.
Take the Phonak brand, for example. The Phonak devices that are reimbursed are from 2018. All devices that they subsequently brought to the market and that are in possession of the latest technology do not therefore fall into categories 1 to 5.
At Starkey you will find very recent hearing aids in the “care” category. The Starkey Livio is a new device. They have made various variants of the Livio. Most advanced hearing aids are not reimbursed. The simplified Livio devices are reimbursed. You cannot activate a speech booster with the simpler devices. It also does not have all kinds of other functions, such as translation.
The hearing aids outside of healthcare have the very latest technology, making them self-learning, rechargeable and some can even translate in real time! In addition to all these gadgets, they are of course also very good in difficult listening situations where the equipment within the healthcare system is often insufficient, such as in a restaurant or during a large meeting. And it is precisely in these situations that we see that people with hearing loss have the greatest difficulty.