Medicare and Hearing Aids

Medicare is a federal health insurance that covers people 65 and older, as well as younger people with certain disabilities and serious diseases. Medicare does not cover all the costs of medical services, and multiple factors determine what types of conditions are covered.

Medicare is divided into three parts:

• Medicare Part A covers hospital stays, skilled nursing facility care, hospice, and some home care.
• Medicare Part B covers certain doctors, services, medical supplies, preventative services, and outpatient care.
• Medicare Part C, or Medicare Advantage, is a bundled plan offered by private insurance as an alternative to Original Medicare. Individual Medicare Advantage plans may cover vision, dental, and hearing.
• Medicare Part D offers prescription drug coverage.

While Medicare does not cover hearing aids, the plan will pay for hearing tests, provided the test is recommended by your primary care doctor or another physician. You cannot go to a hearing clinic without a referral and expect Medicare to pay for the test, so see your primary health care provider first.

With a referral, Medicare Part B (Medical Insurance) will cover diagnostic hearing tests and balance tests. You will pay 20% of the cost of covered exams and the Part B deductible. If the hearing test takes place at a hospital, you may also have to make a copayment to the hospital. There are many independent hearing care professionals, audiologists and ear, nose, and throat doctors who provide free hearing tests, so it pays to do your research. 

Medicare Advantage is a way to receive Medicare benefits through private insurance companies instead of the government. With Medicare Advantage you receive the same benefits as Medicare Part A and Part B, but may also receive coverage for vision, dental, and hearing. 

Medicare Advantage benefits vary depending on the insurer offering the plan. If you already have a Medicare Advantage plan, check with the provider to see if it covers the cost of hearing aids. If you don’t, and want to explore the possibilities of a Medicare Advantage Plan, the Medicare website has a Medicare Plan Finder where you can search for providers by zip code.

The type of Medicare Advantage Plan you choose will determine whether you can see any licensed hearing care professional you want or if you’re restricted to health professionals in the plan’s network. Medicare Advantage plans come in six different forms:

• Health Maintenance Organization (HMO): With an HMO you can only use health care professionals and hospitals who are part of the plan’s provider network (exceptions are made for emergencies). Generally, you will need a referral from your primary physician to see specialists.
• Preferred Provider Organization (PPO): A PPO allows you to see any health care professional you want, but you pay more for doctors, specialists, and hospitals who are outside of the PPO’s network.
• Private Fee-for-Service (PFFS): A PFF, like original Medicare, allows you to see any health care professionals who accepts the plan’s payment terms.
• Special Needs Plan (SNP): A SNP provides specialized health care for specific groups of people, such as nursing home residents or groups who share chronic conditions.
• HMO Point of Service (HMOPOS): HMO point-of-service plan allows you to access out-of-network providers in return for higher copays.
• Medical Savings Account (MSA): An MSA is a high-deductible health plan where Medicare benefits are deposited in a savings account to pay for health care expenses.

If you’re wondering why Medicare doesn’t cover hearing aids, you’re not alone. It seems odd that an insurance plan intended to help older adults would exclude hearing loss treatment, which is a very common ailment after age 65.

The answer lies in the original Medicare Act of 1965, which excluded coverage of hearing aids because they were “routinely needed and low in cost.” Anyone looking at the cost of hearing aids today can tell you “low in cost” isn’t the best way to describe the market, but apparently things were different in 1965.

The original Medicare Act is, quite honestly, behind the times when it comes to hearing aids. The average lifespan of Americans today is higher than it was in 1965. As a result, more people experience age-related hearing loss. The Act was also written before we understood how hearing impacts social isolation and depression, and does not take the psychological impact of hearing loss into account. It also doesn’t consider the fact that hearing loss has since been proven to contribute to both dementia and an increase in accidental falls.

Attempts are underway to modernize Medicare. A bill introduced to Congress in 2019, H.R. 4056, would require Medicare pay for certain audiological services. Whether or not the bill will pass remains to be seen. 

Unlike Medicare, Medicaid is a joint federal and state program that provides medical coverage if you have a low enough income. Whether hearing aids are covered by Medicaid varies from state to state. The Hearing Loss Association of America provides a list of states where Medicaid covers hearing aids. States which do cover hearing aids will have their own rules regarding when coverage is offered and coverage limits.

While Medicare will not cover hearing aids, some private health insurance plans do. Call your provider before scheduling your hearing test to see what your plan covers. Hearing loss impacts all aspects of your life, so if you believe you’re living with limited hearing, make an appointment for a risk-free consultation with a licensed hearing care professional today.