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One of the most interesting aspects of my job as an Audiologist is working out what patients are entitled to with respect to available funding whether it is public or private and working towards securing this funding for them.

In Australia, we have probably the best and most enviable publicly funded hearing services program in the world. The Australian Government’s Hearing Services Program issues funding for around 500,000 hearing aids to pensioners or veterans every year and the number is only growing. Of course with any tax payer funded scheme, there needs to be checks and balances to ensure funding only goes to those who meet specific criteria and when there is a (clinical) need.

The Hearing Services Program in Australia provides eligible participants with access to FREE or subsidised hearing aids every 5 years. The program does however have built in flexibility to ensure patients can get new hearing aids sooner (as in before 5 years) when their circumstances significantly change or when there is a clinical need. This article will explore the various reasons someone may be able to get new FREE hearing aids sooner than 5 years. We will also look at a few specific examples from my own patients.

Who can get a FREE hearing aid in Australia?

Free or subsidised hearing aids in Australia are available to people who can access the Office of Hearing Services Program or the Office of Hearing Services Community Services Obligation Program (see below). To access the first program you need to belong to one of the following categories below:

• Aged Pensioner
• DVA Gold card holder
• DVA White card holder (hearing specific)
• Receiving a Sickness Allowance from Centrelink
• Are a dependent of someone who meets one of the above categories
• Member of the Australia Defence Force
• Referred by Disability Employment Services
• NDIS participant (until July 2019). Read more below for more information about the NDIS

This program doesn’t just provide funding towards hearing aids but also pays for the associated Audiological consulting time, hearing aid maintenance costs and in some circumstances, assistive listening devices.

To qualify for a hearing aid under this scheme, the hearing loss in the specific ear must meet the following criteria:

• The 3 frequency average which is the average hearing thresholds measured when you undergo you hearing test at 500Hz, 1kHz and 2kHz must be at least 25dBHL.

If this criteria is not met, the program still provides the options of a hearing aid if:

• The high frequency average which is the average hearing thresholds measured at 2kHz, 3kHz and 4kHz must be at least 40dBHL; OR
• This ear has annoying tinnitus which a hearing aid may help with; OR
• You have successfully been fitted and used a hearing aid on this ear before.

In all cases, the patient must have good motivation to get a hearing aid. These scheme provides the patient around $500 in funding per hearing aid which is enough to fully fund a basic hearing aid. This device will generally suit most patients although patients are free to choose higher level technology where a gap payment is required.

When Can I get a New Hearing Aid Sooner than 5 Years?

Not everyone is entitled to new hearing aids before the 5 year mark but if you are, your audiologist should be adept at building a case for you. Your Audiologist needs to make sure the case for new hearing aids is strong enough otherwise they may need to repay back any funding you receive from the Office of Hearing Services. For most of my patients who require new hearing aids within 5 years there is usually an obvious refit reason we could apply to their situations. Other times, however, it is not as clear cut and sometimes we need to build a case over several months. Ultimately, the Office of Hearing Services would like to see the following 3 pieces of information detailed by your Audiologist to substantiate a hearing aid refit:

1.  What has changed in the patient’s life, hearing, communication needs or physical condition since their current hearing aids were last fitted?
2. Why are the current hearing aids no longer appropriate and what has been done or tried with them to improve their ability to meet the patient’s needs?
3.  Why will new hearing aids be more appropriate than the current hearing aids at meeting their needs?

The refit reasons provided by the office (listed below) are intended to be interpreted liberally as they would like patients with genuine need to be able to access new hearing aid funding when the need arises. They do however, like the case for new hearing aids to be made with clear clinical reasoning and defensible clinical judgement used.

Office of Hearing Services (OHS) Refit Eligibility Criteria

Below is the OHS refit criteria (pdf version here) that guides Audiologists who provide services to eligible participants under the Australian Government’s Hearing Services Program. It is what I use when trying to build a strong case for my patients.

Refit Criteria 1

The current hearing aid(s) are unsuitable because they can no longer be optimised by adjustments or any other modifications to meet current gain requirements.
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When to use this criteria?
Although this refit reason is generally for those cases where a patient’s hearing has dropped and the hearing aid is no longer powerful enough, this criteria can be used when it is clear that the current hearing aids are no longer clinically appropriate for the patient’s current needs and lifestyle. This is demonstrated in the examples below.

Refit Criteria 2

The current hearing aid(s) are unsuitable because the client can no longer use their aid(s) due to a significant deterioration in health, dexterity or cognitive ability since last fitting.

When to use this criteria?
This refit reason can be used when it is clear that due to a deterioration in health (including vision decline), dexterity or cognition (including memory decline), the current hearing aids are no longer appropriate.  Hearing aids that can assist more in noise maybe more appropriate when someone has both hearing and vision impairment. Rechargeable hearing aids or a complete change in style may also be more appropriate to assist patients with management who have had a deterioration to their health. Often when a loved one moves to a nursing home environment, the transition can be made all the more difficult because hearing in more noise is more challenging. Communication in a quiet home is very different and hence new hearing aids maybe more appropriate.

Refit Criteria 3

A change in physical condition of the ear or ear health has occurred since last fitting and the client requires a different style of hearing device(s) to accommodate this change.

When to use this criteria?

If you have had surgery to your pinna due to a carcinoma removal, then some patients with behind-the-ear hearing aids may need to transition to custom hearing aids that fit entirely in the ear. This is because it may be uncomfortable to have the top part of the hearing aid rest on top portion of the ear. Conversely, if you have had surgery to your ear canal or have experienced narrowing of the ear canal, behind-the-ear hearing aids may be more appropriate than custom devices. Essentially this refit reason can be used when something physically has changed in the patient’s ear that makes their current device no longer suitable.

Refit Criteria 4

The current hearing aid(s) are unsuitable because the client requires a telecoil, and current hearing aid(s) do not have a telecoil and cannot be retrofitted.
Please Note: This situation does NOT allow for refitting with an FM system or streamer or equivalent.

When to use this criteria?

This criteria doesn’t get used that much anymore because since July 2012, patients have needed to opt-out of having a telecoil and this needs to have been documented on the patient’s file. In other words, if your Audiologist has recommended a hearing aid but it doesn’t have a telecoil, you need to be told this and agree that this is okay by you. If you would like more information about telecoils and why they may be useful to have in a hearing aid, visit our post here.

Refit Criteria 5>

Client currently fitted with an Alternative Listening Device (ALD) and now requires hearing aid(s).

When to use this criteria?

This criteria is used when a patient was originally fitted with an ALD (e.g a device for the TV) but has since had a change to their circumstances whereby a hearing aid would now be more appropriate.

Refit Criteria 6

Client’s previous initial fit or refit occurred more than five (5) years ago.

When to use this criteria?

Okay you got me. This refit reason doesn’t allow for a new hearing aid before 5 years or does it? An important thing to note is that if you have been given a replacement hearing aid due to lost who damage beyond repair hearing aids but have not had a new hearing rehabilitation program for 5 years, then technically you would be entitled to new hearing aids. This is true even if you obtained a replacement hearing aid/s 4 years and 364 days since you were last fitted with new hearing aids.

​As far as the Office of Hearing Services is concerned, they look at when the last hearing rehabilitation program was provided, not the last time a hearing aid was “fitted”. Although this is technically true, I (as well as most Audiologists) would never frivolously use tax payer money unless there was a clear reason to refit the patient with new or different hearing aids.

What is a hearing rehabilitation program?

The Office of Hearing Services program funds the services and devices associated with a new hearing rehabilitation program once every 5 years unless there is a clinical need for a new program sooner as allowed for in the above eligibility refit criteria. A hearing rehabilitation program doesn’t just include the fitting of hearing aids but is more encompassing of helping a client reach their hearing potential and communication needs. This may include counselling, providing information about how to improve communication and hearing in various environments, how to manage new hearing aids, discussion about other technology that may help plus more.

This demonstrates the full value of an Audiologist to a patient with hearing loss. Hearing or aural rehabilitation is more than just a device. You can never reach your hearing potential with just a device. With the right guidance and support from an Audiologist, your hearing difficulties can be significantly reduced.

OHS Refit Criteria Applied to Real Scenarios

Maurice – Using  Refit Criteria 1

Maurice was a patient of mine who was previously fitted with Siemen’s Motion 100 P behind-the-ear hearing aids in August 2011. The date that I was considering refitting him was 20th of March 2015 so well within the 5 year automatic refit period. The right hearing aid was in bad working order and in fact was damaged beyond repair. Unfortunately, in March 2015 the manufacturer was no longer stocking the Motion 100 P hearing aid so a simple replacement was not an option. If we replaced the right side, the closest option would be the Siemens Orion P behind the ear hearing aid. This would create a mismatch for this patient which for some can lead to poorer audiological outcomes.

Different hearing aids have different internal digital signal processing units especially if they are 4 years apart in technology. Such a difference can impact sound quality and performance in noise. For Maurice, I decided that it was important to show that his speech perception ability improved when he was receiving the same information synchronously in each ear. To do this, I measured his speech perception abilities for each ear separately (with appropriate amplification) and then did the same for both ears combined. He clearly performed better with 2 ears and as such, I used this to substantiate refitting Maurice with 2 new hearing aids that were identical for both ears.

What also was important to highlight is that Maurice had begun avoiding social gatherings due to his hearing – something he wanted help with. His new hearing rehabilitation program was going to focus on communication strategies to get the most out of his hearing and hearing aids in this social settings as well as focus on device management due to the change or upgrade in technology.

Summary
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1.  One hearing aid had been deemed to damaged to repair and Maurice had started avoiding social gatherings which he wanted help with.

2.  Nothing could be done with Maurice’s damaged hearing aid and a replacement one would create a mismatch in technology with his working hearing aid making it more challenging from a hearing and management perspective.

3.  Refitting both ears would remove the mismatch issue and with better technology as well as a focus on helpful communication strategies, Maurice’s new communication goal/s could be improved upon.

I have found that refit reason one has provided Audiologists with a bit more flexibility than in the past. It isn’t as rigid and allows Audiologists an ability to build a strong case for patients when clinically required.

Tasman – Using  Refit Criteria 1

Tasman was a patient previously fitted with Siemen’s Motion 100 P behind-the-ear hearing aids in May 2013. The date that I was considering refitting him was 21st of April 2015 which was only 2 years after the last hearing aid fitting. Unfortunately this patient had lost his wife so his living situation had changed significantly in this 2 years. In the past he was living a rather quiet lifestyle with his wife but now his family had started taking him out more to restaurants. He was really struggling to hear in this nosier environment especially with basic fully subsidised hearing aids.

I tried adjusting his current hearing aids several times over a few months which didn’t help much as these hearing aids were more geared towards more quiet listening environments. He even tried remote microphone technology with his current hearing aids but he did not manage all the devices too well.

The new hearing aids that were proposed had features that were designed to help Tasman have a better chance of meeting his communication goals – which had now included hearing well in a restaurant environment. Features like narrow directionality, directional speech enhancement, automatic adaptive directional microphone, 48 compression channels, and extended bandwidth could all help.

A new rehabilitation program was going to focus on hearing aid management (Tasman was getting a charger and remote control with his hearing aids and they were a different style to what he was coming from) and communication strategies to get the most out of these new hearing aids. A portion of the new rehabilitation program was going to focus on realistic expectations as Tasman needed help understanding that there were limitations to even better hearing aids but also to how well he physically was able to process amplified sounds now which had declined over the years.

Summary

1.  Tasman’s lifestyle and situation had changed in the last 2 years such that his current hearing aids were no longer appropriate.

2.  Adjustments over the course of several appointments couldn’t improve his communication or hearing enough. Communication strategies were also discussed at length with family members present.

3.New hearing aids with better technology for hearing in noise coupled with practical communication strategies, device management and realistic expectations was going form the basis of a new rehabilitation program for Tasman.

Often you will find that a patient’s needs are not being met with their most recent hearing aid choice. Often there are a lot of things we as Audiologists can do with these hearing aids and the patient to improve their performance. Sometimes just a slight tweak to the hearing aids settings, adding a separate hearing program, changing the coupling to the ear, counselling about proper hearing aid use and/or adding other devices like a streamer or remote microphone can make a huge difference.

Refitting with new hearing aids should always be a last resort unless it is clear and obvious that this needs to happen for improved outcomes for the patient.

Ronald – Using Refit Criteria 2

This patient was previously fitted with a Siemen’s Motion 100 MX behind-the-ear hearing aid on the right in September 2013 and a Siemens Orion M behind-the-ear hearing aid on the left in July 2014.  The date that I was considering refitting him was 23rd of April 2015 which was not that long after these 2 fittings. This patient was having significant management issues with insertion and changing hearing aid programs.

When I saw this patient 6 months earlier, his problems were not as severe, but his dexterity had really declined since then and I felt he would be able to manage custom hearing aids more easily. Custom hearing aids fit entirely in the ear so can be easier to manoeuvre.  This patient has 4 fingers on his right hand and 3 on his left. His GP wanted to get another finger removed but Ronald wanted surgery instead. All in all, a very difficult situation.

Nothing was able to be done with his behind-the-ear hearing aids to make insertion easier for this patient. The fact that he needed to manoeuvre both the top part of the hearing aid behind his ear and a mould into his ear canal was making it too difficult. The proposed custom hearing aids were chosen to make it easier for Ronald to insert as well as physically control his hearing aid programs with the provided e2e technology.

E2E technology enables the synchronicity between hearing aids worn on each ear so that if you adjust the volume or program on one, it automatically adjusts it for the other. This was not possible with his current setup as they were 2 different hearing aids from different technology so they could not communicate with each other. Most hearing aid manufacturers have this basic feature.

Summary

1.  Ronald’s dexterity and decline in ability to manage behind-the-ear hearing aids (insertion and program changes) coupled with having a mismatch in hearing aid technology for each ear required urgent review.

2.  Nothing could really be done to make hearing aid management easier for him with behind-the-ear hearing aids.

3. New custom hearing aids with synchronised technology were recommended to help improve management. A new rehabilitation program would focus on  device management (different style of hearing aids).

This case demonstrates that even if someone received hearing aids 12 months ago, they can be refitted with new FREE or subsidised hearing aids now if their situation has significantly changed and they would be best served by new hearing aid technology.

What if I’m on the Community Services Obligation Program?

The Community Services Obligation program is also administered by the Office of Hearing Services through Australian Hearing and provides for more specialised audiological care for the following patients:

• Children and Young Adults from 0-25 yo who have a permanent hearing loss.
• Young NDIS participants (read this post for more information).
• 50yo+ Aboriginal & Torres Straight Islanders
• Anyone on the Australian Governments Hearing Services Program (as detailed above) but has complex hearing or communication needs (80dBHL hearing loss in the better ear, poor vision or other cognitive issues)
• Eligible patients who live in remote locations.

If you are on this program, you can usually access new hearing aids every 3-4 years depending on your communication needs. The hearing aid usually from higher level technology that would normally be a substantial cost but are fully covered those on this program. This program also covers the cost of more regular audiology consultations and rehabilitation care.

How do I access the  Hearing Services Program?

If you would like to start benefiting from this program and improve your ability to hear or follow conversations and just get on with life, then it is easy to apply. You can either apply yourself or you can consent to an Audiologist or Audiology Clinic to do so on your behalf.

Applying Yourself for the Program

If you are wanting to apply for the program yourself, you will need to go to the Office of Hearing Services website. Make sure you have your pension number or eligible card number available.

The first thing you will have to do is check your eligibility here. You will arrive at page that should look like below.

Select your eligibility type for the drop-down list provided. Most people will have a Centrelink Pensioner Concession Card but just select which one applies to you. Next you will need to enter your eligibility number which includes a letter at the end. Write it exactly how it is on your card. You then just need to enter you given name as shown on the card as well as your surname. Lastly enter you date of birth and gender.

One you have entered the information required, press the ‘Check eligibility’ button at the bottom of the page (looks like the image below).

It usually only takes a few seconds before the system lets you know about your eligibility. If it comes back saying you are not eligible, but you feel that you should be, please contact Centrelink (on 13 24 68) and/or the Office of Hearing Services (on 1800 500 726) to see whether something needs to be updated from their end.

If you are eligible, you will come to a page which requires extra information from you including your address and contact number. Once submitted, you will come to a page which allows you to download and print out a GP medical form which can also be download here. Your doctor needs to fill this form out before you can start receiving services or devices under the Hearing Services Program. You will need to bring this completed form with you to your first appointment with an Audiologist from an Accredited Hearing Services Provider.

You can only receive funding for services and services provided by an Accredited Hearing Services Provider of which Pristine Hearing is one. The program allows patients the flexibility to choose who ever they want to go to in order to receive subsidised services from. If you live in Perth of course we would love you to come to us at Pristine Hearing because we believe our patient care is second to none. We also offer nursing home and home visits.  However, if you cannot come to us, here is a list of providers that you are free to choose from.

Applying for the Program through an Accredited Hearing Services Provider

If applying for the program by yourself looks too much trouble, then never fear, your chosen Audiologist or Hearing Services Provider can do so for you on your behalf. All you need to do is give them a call, provide them with the information they require and bob’s your uncle, they can apply for you. You will still need to bring a completed GP form (downloadable from here) along with you for your first appointment.

If you are child of someone who wants or needs to access this program, as long as you have a Power of Attorney, you are able to apply on their behalf.

Final Words

I hope you have been able to find and discover the information you needed. If you have any further questions or need advice about how to access the Hearing Services Program or how we may go about getting you new hearing aids sooner than 5 years, please fill out the form below or give us a call or 1300 774 284 today.