As you get older, it’s common to struggle with your hearing. If you’re depending on Medicare for coverage, you might wonder if Medicare will cover hearing tests, hearing aids, or cochlear implants.
This guide will review Medicare coverage for these devices and services. Keep in mind that there is a significant difference between the coverage offered by Original Medicare and Medicare Advantage plans.
Here’s what you need to know.
Are hearing aids covered by Medicare? It depends on what plan you have. Original Medicare offers different coverage than a Medicare Advantage Plan. Let’s take a look at how each one covers common hearing needs.
Medicare Part B is part of Original Medicare and offers coverage for some medical equipment. However, this does not extend to hearing aids. Original Medicare does not offer any coverage for hearing aids or fittings. When Medicare was put into place, hearing aids were considered “low cost” and it wasn’t necessary to cover them through the program.
If you have a medically necessary need for diagnostic hearing and balance exams, Medicare Part B will offer coverage. After your deductible, you will be responsible for 20% of the Medicare-approved cost of the exams, and Medicare will pay the rest.
If you have Medicare Part C, known as Medicare Advantage, you will likely have at least some coverage for hearing aids and related equipment. You’ll need to check with the plan for details.
Hearing aids are very expensive, which is why people wonder if Medicare can provide some assistance with the cost. Medicare tracks cost at the national level at ambulatory surgical centers and hospital outpatient departments. Ambulatory surgical centers are a non-hospital facility where certain surgeries may be performed for patients who aren’t expected to need more than 24 hours of care. A hospital outpatient department is a part of a hospital where you get outpatient services, like an observation unit, surgery center, or pain clinic.
The national average total cost of a hearing aid at an ambulatory surgical center is $33,001. That amount is broken down by the average doctor fee, which is $1255, and the average facility fee, which is $31,746.
Medicare will cover $26,401 of this amount on average, so the national average cost of cochlear implants to Medicare patients is $6,600.
The total cost of a hearing aid implant at a hospital outpatient department is $35,682. That amount is broken into $1,255 for the doctor fee and $34,427 for the facility fee.
Medicare will pay $33,947, so the patient pays $1,735 in a hospital outpatient department on average.
These costs include facility and doctor fees. You may need to visit more than one doctor where additional costs may apply.
Medicare Advantage plans with hearing aid coverage can save you a significant amount of money. With some Advantage plans, you’ll pay a deductible for the year and have a copayment for services, but you won’t pay the full cost of hearing aids. The good news is that over 90% of Advantage plans have at least some benefits for hearing aids.
Unfortunately, the rules for hearing aids for tinnitus are the same as other hearing aids. Original Medicare offers no coverage for the devices or fitting.
The good news is that Medicare Advantage plans often do, so you’ll need to review your plan and contact your insurer to find out more.
Original Medicare does offer coverage for cochlear implants, but it’s important to understand how these implants differ from hearing aids. You may or may not qualify for these devices.
Cochlear implants are used for those who are deaf or have severe hearing loss. This electronic device stimulates the auditory nerve through electrodes in the cochlea of the inner ear. An implant can help restore partial hearing to those who are deaf or profoundly hard of hearing.
Cochlear implants are an option for people whose hearing loss is too severe for hearing aids. Instead of amplifying sound, like a hearing aid, the implant bypasses hearing damage to deliver sound to the auditory nerve.
To get coverage from Original Medicare for cochlear implants, you have to meet specific criteria. These include:
If you meet the standards above, you may qualify to have Original Medicare coverage for your cochlear implant. If that’s the case, it will be covered at the normal level, where you pay any deductible remaining for the year and then 20% of the Medicare-approved cost, and Medicare pays the rest.
This guide answered the most common questions about Medicare coverage and hearing aids, but you may have additional questions about your specific situation. We’re here to help. If you’d like to talk to a licensed insurance agent about Medicare coverage for hearing aids, or need help finding the right Medicare plan for your needs, contact us today!