PrimeTime Health Plan Medicare Advantage

The PrimeTime Health Plan Medicare Advantage hearing program is a new Medicare Advantage funded benefit plan through Amplifon. This plan went into effect as of January 1, 2019.  You will follow the standard process (found in the provider portal) with the additional requirement of the Medicare Advantage disclosure form.

1. Member is referred to clinic and appointment is scheduled.
2. Amplifon verifies insurance benefits.
3. Provider collects $25 hearing test copay at the time of service. 
4. Provider must submit hearing test claim to the plan.

Pre-Fitting information:

1. Member is referred to clinic and appointment is scheduled.
2. Amplifon verifies insurance benefits.
3. Provider informs member of the copay - $695, $795 or $995 dependent on product pricing tier.
4. Provider informs member of the hearing aid benefit - $100 per device. An example of how this impacts a member's cost:
   

   
   A. Device Cost/Copay           $795
   B. Funded Benefit                  $100
   C. Patient Responsibility      $695 (A - B = C) ($795 - $100 = $695) 
    

5. Members can purchase higher priced hearing aid(s); however, the difference between their copay and the device cost is the upgrade amount they owe. The member's out-of-pocket responsibility is the copay along with the upgrade amount, minus their funded benefit. For example:
   
   

   
   A. Device Cost                       $1,795
   B. Copay                                 $795
   C. Upgrade Amount             $1,000 (A - B = C) ($1,795 - $795 = $1,000)
   D. Funded Benefit                 $100
   E. Patient Responsibility      $1,695 (B + C - D = E) ($795 + $1,000 - $100 = $1,695)
    

6. Provider recommends hearing aid(s) and disclosure form is generated from Amplifon Lite and must be reviewed and signed by member.
7. Provider orders from the manufacturer using the appropriate Amplifon bill-to number and your ship-to address. Please reference the PO reference number located on the Receipt of Delivery form. Amplifon pays the manufacturer for hearing aids and earmolds.

Fitting and Payment:

1. Hearing aid(s) must be fit by a provider in the PrimeTime Health Plan Medicare Advantage associated network.
2. Patient pays in full. Payment to Amplifon may be made via e-check or credit card through the provider portal, or through Care Credit and must be forwarded to Amplifon. If patient cannot pay by e-check, credit card, or Care Credit, then payment by check will be accepted. Checks should be made payable to Amplifon Hearing Health Care.
3. Please send the signed Receipt of Delivery and disclosure form along with the packing slip from the manufacturer to Amplifon Hearing Health Care within 24 hours of fitting.

• 2 year free supply of batteries with every purchase.
• The first year supply of batteries will be mailed to the member’s home, along with a reminder letter to contact Amplifon for their second year of free batteries.
• After their two year supply is depleted, the member may contact Amplifon to find out if additional battery coverage is available.

• Amplifon Hearing Health Care must have a completed W-9 from you in order to process your dispensing fee. 
• You will be paid 60 days after the delivery date. Standard dispensing fees apply.

If you have any questions regarding our new partnership with PrimeTime Medicare Advantage, don’t hesitate to call Amplifon at 1-800-920-4327.