Summary: Though hearing loss impacts a significant amount of people, Medicare only provides limited coverage for hearing-related services. In this article, we’ll explain what Medicare covers regarding hearing aids, cochlear implants, hearing exams, and more. When it comes to hearing care, Medicare enrollees have options to get additional coverage and reduce their costs. Estimated Read Time: 6 min
The Importance of Hearing Health Care for Adults
Compared to vision or dental care, many people overlook the importance of hearing health. Roughly one in three people in the U.S. between ages 65 and 74 have hearing loss. Hearing loss can affect not only our ability to communicate and socialize with others but is also linked to higher rates of cognitive decline in older adults. Though hearing loss can have a significant impact on our lives, many people wait years to get any sort of help.
As with most health conditions, it is better to address hearing loss while it is mild instead of waiting for it to worsen. For Medicare enrollees to get the hearing healthcare they need, it’s important to understand which services and items are covered. Below, we’ll review whether Medicare covers hearing aids, hearing exams, and how you can get help with out-of-pocket costs.
Does Medicare Cover Hearing Aids?
Medicare does not cover hearing aids or exams for getting hearing aids fitted. Hearing aids are small electronic devices that help amplify some sounds so an individual with hearing loss can listen and communicate better in their daily lives. Hearing aids can come with a variety of features and the average price can range from $1,000 to $3,500 per hearing aid ($2,000 to $7,000 for a pair). This cost often includes the cost of the device itself as well as an exam for getting it fitted.
The National Council on Aging reports that 28.8 million American adults need hearing aids, but only 16% of people between the ages of 20 and 69 who need hearing aids use them. With an aging population, we can expect there to be an even greater need for hearing aids over the next couple of years. Unfortunately, the cost of hearing aids is a significant obstacle for many people, especially considering Medicare does not provide coverage.
Why Doesn’t Medicare Cover Hearing Aids? You may be wondering why hearing aids aren’t included in Original Medicare’s coverage. You may be surprised to learn that though the Medicare program has seen many changes since its inception, there haven’t been many changes to the coverage that Original Medicare offers. When Medicare was passed into law in 1965, it did not include coverage for hearing, dental, or vision. As of 2024, that hasn’t changed even though expanding Medicare coverage has been a commonly debated topic over many years.
Medicare Coverage for Cochlear Implants
Cochlear implants are small electronic devices that consist of two parts: an external portion that sits behind the ear and a second portion that is surgically placed under the skin. This device is used to help provide a sense of sound to a person who is deaf or severely hard-of-hearing. Medicare Part B will cover cochlear implants for individuals who meet specific criteria. An individual may qualify for coverage if they demonstrate a limited benefit from amplification.
CMS defines limited benefit from amplification by test scores of less than or equal to 60% correct on recorded tests of open-set sentence recognition. These tests are done while receiving the best-aided listening conditions possible. In addition to displaying a limited benefit from hearing amplification, you must also meet other criteria including a willingness to undergo rehabilitation and your ear being physically fit for the implant. Talk to your doctor about whether you meet Medicare’s requirements to have your cochlear implants covered.
After receiving a cochlear implant, you will need to receive rehabilitative services to learn to interpret the sounds created by the implant. These rehabilitative services often involve speech-language pathologists and audiologists. Speech-language pathology services are covered by Medicare Part B when deemed medically necessary by your doctor or health care provider.
Does Medicare Cover Hearing Tests?
There are limited situations where Medicare will cover hearing tests and exams. When Medicare does cover a hearing exam, your Medicare Part B will be billed. This means you will be responsible for paying a 20% coinsurance of the Medicare-approved amount for the exam or test. You may also need to pay a hospital copayment if receiving the test or exam in a hospital outpatient setting.
Medicare will cover hearing tests under the following circumstances:
- Your doctor or health care provider orders a diagnostic hearing and balance exam to find out whether you need medical treatment.
- You have a non-acute hearing condition and see an audiologist once every 12 months.
- You receive diagnostic services related to hearing loss that’s treated with surgically implanted hearing devices (such as a cochlear implant or auditory brainstem implant).
As mentioned above, Medicare does not help pay for hearing aids. Medicare will also not cover any exams for getting hearing aids fitted, or any routine hearing exams that do not meet the requirements above.
Do Medicare Advantage Plans Cover Hearing Aids and Exams?
Medicare Advantage plans are not required to cover most hearing care, including hearing aids. The federal government requires Medicare Advantage plans to offer at minimum the same coverage offered by Original Medicare. Therefore, Medicare Advantage plans must cover Medicare-approved Cochlear implants, as well as hearing and balance exams deemed necessary by your doctor.
However, it is important to understand that even though Medicare Advantage plans must cover Medicare-approved hearing services, you may be required to go to a health care provider in your plan’s network.
Some Medicare Advantage plans may offer coverage for items and services outside of what is normally covered by Original Medicare. Review plan summaries carefully to understand which services are covered and what your out-of-pocket costs will be.
Standalone Insurance Plans for Hearing Care
Medicare beneficiaries can enroll in a standalone Dental, Vision, & Hearing plan. These plans, often referred to as ancillary insurance plans, are plans that provide specific coverage and are available to most people. Dental, Vision, & Hearing plans bundle together the three major areas of care that Medicare does not provide coverage for. These plans often include coverage for a yearly routine hearing exam, as well as partial coverage for hearing aids.
Availability, benefits, and costs of Dental, Vision & Hearing plans will vary between locations and carriers. These plans are offered by private insurance companies and operate separately from Medicare. You can enroll in a Dental, Vision & Hearing plan regardless of whether you have Original Medicare or a Medicare Advantage plan.
How to Get Help with the Cost of Hearing Aids
Though Medicare doesn’t cover hearing aids, there are ways for Medicare enrollees to reduce their costs.
Medicaid may provide reimbursement for hearing services and supplies, including hearing aids and cochlear implants. If you qualify for Medicaid, contact your state’s Medicaid office to see which hearing services are covered.
Consider Over the Counter (OTC) hearing aids if you have mild to moderate hearing loss. As of October 2022, the FDA established a new category of over-the-counter hearing aids for adults aged 18 and older. These hearing aids can be purchased at a store, through an online retailer, or from a hearing health professional. OTC hearing aids are less expensive than prescription hearing aids, but they may lack the fine-tuned settings and fit that prescription aids have.
Explore national and state resources and programs that assist with the cost of hearing aids. The Hearing Aid Project has an easy-to-use directory to help you find resources near you. If you don’t qualify for any programs in your area, you can apply for aid directly through the Hearing Aid Project.
Getting help for hearing loss while it is mild can make a significant difference in your hearing health. Though Medicare provides limited coverage, there are many options available for Medicare enrollees for getting the coverage they need. If you have questions regarding what is and isn’t covered by Medicare and would like to speak with someone, give us a call. Our licensed insurance agents can help answer your questions about what Medicare does and doesn’t cover.
Sources
Only 1 in 6 Americans with Hearing Loss Wears Hearing Aids – Here’s Why, National Council on Aging. Accessed December 2023
https://www.ncoa.org/adviser/hearing-aids/low-hearing-loss-treatment-reasons/
National Coverage Determination (NCD) Cochlear Implantation, Centers for Medicare & Medicaid Services. Accessed December 2023
https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=245&ncdver=3
Hearing & Balance Exams, Medicare.gov. Accessed December 2023
https://www.medicare.gov/coverage/hearing-balance-exams
OTC Hearing Aids: What You Should Know, U.S. Food & Drug Administration. Accessed December 2023
https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know
