Medicare covers diagnostic hearing tests when they are ordered by a doctor or healthcare provider to determine if medical treatment is needed for hearing-related issues. Under Medicare Part B, these tests are covered if deemed medically necessary due to symptoms such as hearing loss, dizziness, or balance disorders. While Medicare pays 80% of the approved cost after the Part B deductible is met, the patient is responsible for the remaining 20%. However, Medicare does not cover routine hearing exams, hearing aids, or exams for fitting hearing aids. To ensure coverage, the diagnostic hearing test must be conducted by a Medicare-approved provider.
Some hearing loss might be expected as we age, but hearing issues should never be ignored. When hearing or understanding those around you becomes difficult, loss of hearing can significantly impact your quality of life, even when consulting with another health care provider.
One of the obvious solutions to hearing loss is to take eligible hearing tests and then purchase hearing devices. Although the solution is straightforward, the cost it involves is not. Both the hearing test and hearing device costs can be beyond reach for many.
This article will answer questions like “Does Medicare cover a hearing test?” and “Is it possible to find affordable hearing solutions?” among other inquiries. Can my primary care physician perform a hearing exam?
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Does Medicare Cover Liestening Tests?
Yes, under select conditions. Your Medicare covers diagnostic hearing and balance exams provided your doctor has recognized a medical need for them. Your doctor can provide you with a script to have a medical examination if you start experiencing hearing loss and have issues with balance, indicating a medical need.
Hearing tests are done by an audiologist, not your primary care doctor or physician’s assistant.
Medicare coverage includes seeing an audiologist once every 365-days. However, your visits are limited to the examination of non-acute hearing conditions or doctor’s services related to surgically implanted hearing devices.
Introduction to Medicare Coverage
Navigating Medicare coverage for hearing devices and exams can be a bit complex, but understanding the basics is crucial. Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), does not cover the cost of hearing devices or routine hearing exams for adults. However, Medicare Part B may cover diagnostic hearing assessment if they are ordered by a healthcare provider, such as your primary care physician or a specialist like an ear, nose, and throat doctor. These diagnostic exams are essential for identifying hearing loss or other hearing-related issues. Medicare Part B durable medical equipment coverage works in different ways for every DME equipment type.
On the other hand, Medicare Advantage plans, also known as Medicare Part C, may offer additional coverage for hearing devices and exams. These plans often include benefits for routine hearing evaluation and fittings, which are not covered by Original Medicare. It’s important to review the specific benefits of your Medicare Advantage plan, as coverage can vary significantly from one plan to another and may change annually. Understanding these options can help you make informed decisions about your hearing health and manage the associated costs effectively.
Does Medicare Cover Listening Exams for Routine Care?
If you want routine hearing evaluation or other hearing related tests, Medicare won’t cover those expenses. Nor will Medicare cover hearing devices.
The benefits for these devices are not a part of traditional Medicare. Some Medicare Advantage plans may offer limited coverage for hearing devices. But those benefits can change annually.
However, there are other insurance programs we offer that provide financial help with hearing-related costs. I will discuss this further in this article.
Does Medicare cover diagnostic hearing exams?
Diagnostic hearing services play a vital role in maintaining good hearing health. Medicare Part B covers diagnostic hearing evaluation, which are essential for diagnosing hearing loss or other hearing-related problems. These exams must be ordered by a healthcare provider, such as your primary care physician or an audiologist, to be covered. Diagnostic hearing evaluation can be conducted in various settings, including a hospital outpatient setting or a doctor’s office.
When it comes to costs, Medicare typically covers the Medicare-approved amount for these services, with the beneficiary responsible for paying 20% of the cost. This includes doctor’s services related to diagnostic hearing exams. This cost-sharing approach ensures that you have access to necessary diagnostic services without bearing the full financial burden. Additionally, Medicare Advantage plans may also cover diagnostic hearing services, including hearing evaluation and exams, with varying levels of cost sharing. It’s essential to review your specific plan details to understand the coverage and out-of-pocket costs associated with these services. By staying informed, you can better manage your hearing health and ensure you receive the necessary diagnostic care.
Audiology Services and Balance Exams
Audiology services and balance exams are crucial for diagnosing and managing hearing loss and balance-related disorders. Medicare Part B covers diagnostic hearing and balance exams if they are ordered by a doctor or other healthcare provider. These exams help identify underlying health issues that may be affecting your hearing or balance.
When it comes to audiology services, Medicare covers diagnostic hearing exams deemed medically necessary by a healthcare provider. These exams can be conducted in various settings, including a hospital outpatient setting or a doctor’s office. Balance exams, which are essential for diagnosing and treating balance-related disorders, are also covered by Medicare Part B when ordered by a healthcare provider.
Medicare beneficiaries should be aware that they may need to pay a copayment for balance exams and other diagnostic services conducted in a hospital outpatient setting. Typically, Medicare covers 80% of the Medicare-approved amount for these services, with the beneficiary responsible for the remaining 20% after meeting the Part B deductible. This cost-sharing approach helps reduce out-of-pocket costs for audiology services.
Medicare Advantage plans may offer additional coverage for audiology services, including balance exams and hearing evaluation. These plans often provide extra benefits that are not available under Original Medicare, such as routine hearing evaluation and other hearing-related services. Coverage can vary by plan, so it’s essential to review your specific plan details to understand the benefits and out-of-pocket costs associated with these services.
If you suspect you have hearing or balance issues, it’s important to check with your healthcare provider to see if you need a referral for audiology services or balance exams. Some services may require a referral to be covered by Medicare. By staying informed and proactive about your hearing health, you can ensure you receive the necessary diagnostic care and manage any hearing or balance issues effectively.
What Does Medicare Pay for (Hearing Test, Surgical Treatment, Listening Aids, etc.)?
Medicare covers eligible hearing evaluation and treatments whenever a physician prescribes the tests for medical reasons, but it is important to note that certain services, including doctor’s services, may not be covered and could incur out-of-pocket costs. Age-related loss of hearing is not considered a medical reason. Medicare Part B coverage may include diagnosis, balance exams, and medical treatments, and such tests are essential for assessing and diagnosing various hearing and balance issues.
Additionally, a policyholder may visit an audiologist for hearing aid fittings once every 12 months without health care provider orders. Note that this is possible only for:
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Non-acute hearing conditions
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Diagnostic hearing exam, related to hearing loss treatment (with a surgically implanted device).
What Do Medicare Advantage Plans Cover?
Some Medicare Advantage Plans may have limited coverage for routine hearing care, devices, and hearing and balance exams. This can include doctor’s services related to these exams.
Medicare Advantage plan (also known as Medicare Part C) may include benefits to reduce the cost of select hearing devices, sometimes including a fitting exam. Please read the plan Summary of Benefits carefully for details.
The benefits you have access to are listed in your insurance summary and will vary from plan to plan as well as annually. Some will partially cover hearing devices, including fitting. Please read your Summary of Benefits carefully.
A Word of Caution Regarding Medicare Advantage & Hearing Devices
It is never wise to focus on just one benefit of a Medicare Advantage Plan. Often Medicare Part C plans will offer hearing device benefits at the expense of other medical treatments. Always focus first on the cost of regular Medicare coverage, regular medical treatment, your physician network, primary care physician and drug coverage. Only after those outpatient care needs are met is it wise to compare hearing benefits or devices.
Signs You Need a Hearing Aid
There are visible signs of hearing loss that you may notice without going to your physician. However, it doesn’t mean every symptom is the same, so you should always address your concerns with a health care provider.
Generally, any person should be able to hear whispers, which is about 25 decibels. If you struggle with hearing anything below 30 decibels, a hearing aid might be necessary. Other obvious signs may include:
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Hearing a ringing sound in your ears
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Watching television or listening to music at high volume
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Speaking louder than usual
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Problems understanding the other person on the phone
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Struggling to hear someone in a noisy environment
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Group conversations become harder to understand
Hearing devices are designed to help you hear human speech and sounds clearer. The device amplifies the sounds in the ear, making them louder. They aren’t capable of improving the natural ability to hear well — instead, they act as a supportive mechanism for hearing assistance.
Depending on your case, you may need only one device, but some cases where two devices are needed for both ears aren’t exceptions.
How Much Do Hearing Aids Cost?
Hearing devices, including surgically implanted hearing devices, vary in their functions and features; therefore, the price may also range from $1,000 to $7,000 per device. The initial out-of-pocket cost is high; therefore, having reliable insurance will help you lower the total expense of the device and its maintenance.
The price depends on the device’s features (e.g., battery type, water resistance, compatibility with smartphones, etc.), degree of hearing loss, and other expenses for hearing evaluation and fitting. You may also have additional medical insurance to help pay the out-of-pocket costs, but some expenses must still be paid by the patient.
There are four main types of hearing devices:
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Behind-the-ear (BTE) devices: The device sits behind and over the ear with a small tune (with a sound amplifier) covering the ear opening. This device is often used for children.
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Receive-in-canal (RIC) devices: This device looks fairly similar to the BTE version, but it has a tiny speaker placed in the ear canal.
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In-the-ear (ITE) devices: This hearing aid has a smaller shape and covers only the ear opening (similar to modern wireless earphones). The device is custom-made to fit the ear firmly.
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Completely-in-the-canal (CIC) devices: This device is the least visible of all because it is positioned in the ear canal. There is a short string that remains outside the ear for easier removal.
All of the devices mentioned are suitable for people with moderate and severe hearing loss.
Medicare Hearing Aid Coverage Options
Since Original Medicare doesn’t provide coverage for Listening aids, people tend to seek other ways to finance their investments in health. Medicare Advantage plans can become a solution to partially cover the costs of getting a hearing exam and a device.
Local Lions Clubs are part of a broader network of civic and nonprofit organizations that assist individuals in accessing affordable Hearing devices. Some local Lions Clubs run projects aimed at providing Hearing devices to those in need, making them a valuable resource for community support in hearing assistance.
The amount your plan will cover will depend on your individual insurance and the specifics of the plan. It should be noted that, according to the Kaiser Family Foundation, 88% of Medicare Advantage plans offer some hearing aid coverage. Additionally, there are various resources and support systems available for low-income individuals seeking help with the costs of hearing aids, such as the Hear Now program and local Lions Clubs.
Again, we advise not to focus on just one benefit. If a Medicare Advantage Plan is offering extra benefits that include hearing services, they are likely reducing other benefits or restricting Medicare beneficiaries access in order to make up for it. Medicaid services can also provide assistance and benefits for individuals requiring audiological devices and rehabilitation services.
It’s up to you to investigate your benefits and decide which is most important. State charitable programs are also valuable resources for individuals seeking financial assistance for Hearing devices, connecting those in need with funding for hearing aid costs.
Does Medicare Supplement (Medigap) Cover Listening Aids?
Similar to Medicare Part A and Part B, Medigap plans do not cover audiology services. A Medicare supplement simply pays the deductibles and coinsurance of procedures or equipment approved by Original Medicare. According to Medicare rules, the Medicare beneficiary is the one responsible for purchasing the hearing device.
Normally, Medigap plans pay the 20% of the Medicare-approved amount you would have to pay for a doctor’s visit and any exams ordered by your nurse practitioner or physician.
Hearing Coverage Alternatives
Getting a hearing aid is not something you should postpone, even when the financial situation isn’t ideal. Apart from Medicare plans, there are medical insurance alternatives Medicare beneficiaries can use to help you cover hearing evaluation and devices. You can also seek assistance from an audiologist or other health care provider for referrals and necessary services related to hearing assessments.
One alternative is a stand-alone hearing insurance product offered by a private insurance company. Additionally, you will find the best hearing coverage bundled with dental insurance products. These Dental, Vision & Hearing plans can be a great option for hearing aid coverage. Just keep in mind, not all will include hearing aid coverage.
If you served in the U.S. Military, the U.S. Department of Veterans Affairs has a program for eligible veterans that covers the costs of medical examination, fitting, and repair of Hearing devices.
Cover Hearing Aids and Exams Costs with Medicare Plans
If you want your health insurance plan to cover the costs of hearing tests and aids, you can investigate Medicare Advantage plan options. If you are already enrolled in a different Medicare plan or are new to the whole insurance plan, I advise you to get in touch with an expert and discuss what option you have.
Hearing Health and Medicare
Maintaining good hearing health is essential, but understanding what Medicare covers can be a bit complex. Original Medicare (Parts A and B) does not cover routine hearing exams, Hearing devices, or exams for fitting Listening aids. However, it does cover some diagnostic hearing and balance exams, which are crucial for identifying hearing loss and other related health issues.
Medicare Part B covers eligible hearing evaluation, including diagnostic hearing exams, once the annual Part B deductible is paid. These exams must be ordered by a healthcare provider, such as your primary care physician or an audiologist, to be covered. This coverage helps identify hearing loss and other hearing-related problems, ensuring you receive the necessary medical attention.
Medicare Advantage plans, also known as Medicare Part C, may offer additional benefits for hearing health. These plans often cover Listening aids, exams for fitting Hearing devices, and other hearing-related services. The coverage can vary significantly from one plan to another, so it’s important to review your plan’s details to understand the benefits and out-of-pocket costs associated with these services.
For Medicare beneficiaries, out-of-pocket costs for Hearing devices and exams for fitting hearing aids can be significant if they are not covered by their Medicare plan. However, there are resources available to help reduce these costs. State charitable programs and local organizations, such as the Lions Clubs, may offer financial assistance for Listening aids and other hearing-related services. These programs can be a valuable resource for those in need of hearing assistance.
It’s crucial for Medicare beneficiaries to check with their healthcare provider to see what hearing-related services are covered under their Medicare plan. Coverage can vary, and understanding your plan’s benefits can help you manage your hearing health more effectively. Additionally, beneficiaries should also explore whether Medicare covers dental services, as dental health is crucial for overall well-being. Medicare Advantage plans may offer extra benefits, including hearing coverage, which can be found in the Plan Details section. These additional benefits can provide significant support for maintaining good hearing health.
When reviewing your Medicare plan options, ensure you have the coverage you need for hearing health services, including audiology services and balance exams. By staying informed and proactive, you can make the best decisions for your hearing health and overall well-being.
Frequently Asked Questions
Medicare covers only the diagnostic hearing and balance tests and treatment ordered by your physician for medical reasons, and does not cover diagnostic hearing service. Medicare coverage does not include routine checkups and hearing aid devices.
You may be eligible for state charitable programs or state coverage of hearing service expenses. There are other insurance alternatives like the Medicaid program for low-income families, health insurance plans for retirees, and the U.S. Department of Veteran Affairs financial help for veterans.
In the U.S., you are likely to pay for hearing evaluation without insurance coverage, and knowing what expenses must be paid is crucial. Hearing devices are expensive, so having private health insurance coverage is best for insurance to cover hearing exams, cover Listening aids, fitting Listening aids and other hearing services.
Medicare covers diagnostic hearing evaluation, balance exams, ringing in the ear, and some treatments if you have a referral from your doctor for hearing issues. If your hearing problems are due to a disease or injury, Original Medicare is more likely to cover some of the costs.
If your health care provider orders an exam, the Original Medicare approved amount will depend on its medical necessity beyond routine hearing ailments.
No, Medicare cover will not cover hearing aid or exams for fitting Listening aids. As a Medicare beneficiary, you are responsible for paying 100% out-of-pocket for the device and necessary tests. On the other hand, there are alternatives I have described above that could lower the your cost.
Unfortunately, older adults with tinnitus will not be covered by the Original Medicare insurance plan. One of the alternatives described above might be a way to reduce the total expense with the help of an audiologist or other health care provider.
Traditional Medicare and other private insurance companies choose not to cover hearing aids because their mandate is to cover diseases and conditions. Hearing loss due to age is neither.
Additionally, Medicare is a federal health insurance program that is currently prevented from covering the cost of hearing devices. However, this may change in the future, potentially including coverage in a hospital outpatient setting with the involvement of an audiologist or other provider.
In 2021, the H.R.1118 Medicare Hearing Aid Coverage Act was proposed, which would simplify the life of numerous patients.
Conducting a hearing test at home sounds tempting and easy — however, the reliability of it is doubtful. Some conditions (e.g., vertigo, tinnitus, etc.) should be checked only by a professional audiologist or other health care provider. The degree of hearing loss isn’t the only determining factor, ear shape, past illnesses, and ear canal condition are all taken into account.
Recently, hearing aids have become available in the United States without prescription. While an over the counter hearing aid is not typically of the same quality as a prescribed device, they can be a good solution for those just starting to lose their hearing. It’s better to have an over the counter hearing aid than suffer through a conversation with family or friends without the help of an aid.
