Medicare coverage and hearing aids

Medicare is a federal health insurance program that covers people who are 65 or older, as well as younger people with disabilities or serious diseases.

However, Medicare does not cover all costs of medical services, which is where the rules get tricky.

There are a number of factors affecting coverage of hearing aids, so it is imperative you take the different kinds of coverage available into consideration.

Understanding Medicare

Medicare (Part A and B), also known as Original Medicare

Medicare coverage is designated by Parts. If you’re eligible for Medicare, you have the option of getting Original Medicare (Part A and Part B), or a Medicare Advantage plan (Part C).

Original Medicare, comprised of Part A and Part B, does not cover the cost of hearing aids, nor the exams needed to fit them.

Neither does Medigap, a type of supplemental insurance. Medigap is purchased through private insurers. You can only use Medigap to pay your out-of-pocket expenses for services Original Medicare covers. You can’t use Medigap to pay for things Original Medicare doesn’t cover, like hearing aids. 

Medicare Part C (Medicare Advantage)

Medicare Part C, also known as Medicare Advantage, is an insurance coverage alternative to Original Medicare. Part C plans vary, but often provide coverage for hearing care that includes hearing aids. To get Medicare Advantage, you must first enroll in Parts A and B.

Most people who are eligible for Original Medicare are automatically eligible for Medicare Part C. (People with end-stage renal disease (ESRD) may not be able to get a Part C plan.)

Part C plans are sold by private insurers. By law, Part C plans must cover everything Original Medicare does, such as hospitalizations and annual checkups.

Many Part C plans require you to use in-network providers. Unlike Original Medicare, which includes nationwide providers, Part C networks are often confined to one or two states.

Part C usually provides good hearing aid coverage

“Most Medicare Advantage plans include a hearing aid discount or funded benefit. Many include a discount plan for hearing aids that require you to purchase your hearing aids from a third-party payer (also called a third-party administrator),” explains Blaire Driscoll, practice administrator for Gardner Audiology in Tampa, FL.

Part C plans may also cover prescription drugs, eyeglasses, dental care, and other “extras,” such as Silver Sneakers gym memberships. The “extras” you get, as well as their out-of-pocket costs, vary from plan to plan, Driscoll notes.

Since your healthcare needs are bound to encompass more than just hearing aids, she cautions that it’s important to check out everything a Part C plan offers before you buy.

Part C plan availability varies by county and state. You can use Medicare’s Find a Plan Tool to look up and compare the plans that are available in your zip code.

How to get Part C

You can buy a Part C plan during your Initial Enrollment Period, when you first become eligible for Medicare. If you already have Original Medicare or a Part C plan that doesn’t cover hearing aids, you can change to a new plan that includes hearing aid coverage during these annual timeframes:

• Medicare open enrollment: October 15 - December 7
• Medicare Advantage open enrollment: January 1 – March 31

Does Medicare pay for hearing tests?

In some cases, yes, but only if recommended by your primary care doctor or another physician. In other words, you can't go to a hearing clinic without a referral and expect Medicare to pay for it.

Here's how Medicare explains hearing exam coverage: "Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay 20% of the Medicare-approved amount for your doctor's services for covered exams, and the Part B deductible applies. Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids."

How to apply for Medicare

For convenience, you begin the process to apply for Medicare on their website. You can use the online form to sign up for Medicare coverage, even if you are not ready to retire.

If hearing loss is affecting your ability to work, you can also look into Social Security disability benefits.

Other ways to pay for hearing aids

Wondering if you have other options? We have an in-depth page on using insurance and financial insurance to help pay for hearing care and hearing aids.

Why doesn't Medicare cover hearing care?

As this clinical review explains, "The Medicare Act of 1965 statutorily excluded coverage of hearing aids under the premise that they were 'routinely needed and low in cost,' suggesting that consumers would be responsible for their purchase." Also, at the time, many seniors didn't live as long as they do today, and so fewer people had age-related hearing loss. 

Will coverage on hearing aids change? 

Over the years, many organizations and lawmakers have tried to update Medicare to cover vision, hearing and dental costs for seniors.

Many people would like to see Medicare evolve to cover dental, vision and hearing care. A Commonwealth Fund report details the financial and health burdens these gaps place on older adults. The report said:

"Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year."

However, so far, no one has been successful at getting changes made to this part of Medicare coverage. In the summer of 2019, several U.S. representatives introduced H.R. 4056, a bill that would require Medicare to pay for certain audiological services. Time will tell if this bill gets passed.

Don't let hearing loss hold you back

Addressing hearing loss is good not just for your health, but your social life, too.

If you have questions about hearing loss and how to pay for hearing aid services, a hearing healthcare professional in your area may be able to help you.