The hearing coverage under Medicare Advantage can include some or all of the following: a hearing exam, a hearing aid evaluation, a hearing aid fitting and the hearing aids. | Image: Dusko / stock.adobe.com
As you get older, odds are you will have some degree of hearing loss. The National Institutes of Health reports that one-quarter of people between 65 and 74 years old and half the people over 75 years old have hearing loss. This not only impacts seniors’ quality of life but it can also be a safety issue if it is not addressed.
Even though so many Medicare beneficiaries experience hearing loss, Original Medicare (Part A and Part B) offers limited coverage. While Original Medicare does cover a hearing screen for anyone who has symptoms – hearing loss or ringing in the ears, for instance – it stops short of paying for hearing aids, even after a problem has been diagnosed.
Part B may pay for cochlear transplants for people with hearing loss. These electronic devices can restore hearing by directly stimulating the nerve responsible for hearing, i.e., the cochlear nerve. Interestingly, one of the requirements that must be met to get a cochlear implant is that you have to have tried hearing aids but they were ineffective. It is somewhat ironic that hearing aids are not covered in the first place.
Part A and Part B also do not cover routine hearing screening tests. This is unfortunate because many people do not address gradual hearing loss until it is too far gone.
Thankfully, there are a number of Medicare Advantage (Medicare Part C) plans that offer hearing coverage as a supplemental benefit.
Which Medicare plans or parts cover hearing aids?
As noted above, Part A and Part B do not cover routine hearing tests or hearing aids, but some Medicare Advantage plans (Part C) do offer the benefit.
If this coverage is something you’re interested in, you’ll need to shop for a Medicare Advantage plan that offers the benefit. The good news is that shouldn’t be too hard to find one: In 2021, 88% of Medicare Advantage plans offered coverage for hearing aids.
If you want to compare Medicare Advantage plans – or enroll in one – consider “shopping around” during the annual Medicare open enrollment period, which starts October 15 and continues through December 7.
NOTE: Do not confuse Medigap with Medicare Advantage plans’s supplemental benefits. Although Medigap plans are referred to as Medicare supplement insurance, they do not include the supplemental benefits that Medicare Advantage plans offer. You may see a lot of marketing during Medicare open enrollment about both types of plans. A Medigap plan will not help you pay for hearing aids.
Call 1-844-309-3504 now to learn more about Medicare supplemental benefits with a licensed advisor.
What does Medicare Advantage's hearing aid coverage include?
The hearing coverage through Medicare Advantage can include some or all of the following: a hearing exam, a hearing aid evaluation, a hearing aid fitting, and of course, the hearing aids themselves. Each of these services may have their own copay, though some plans may offer the exams for free. Sorry to say, the hearing aids themselves are rarely free.
Your plan may require you to get a physician referral before your hearing coverage kicks in. When it comes to the hearing aids, each plan may have preferred brands they will cover and they may also have limits as to how much they will pay.
What does hearing aid coverage cost?
If you are getting hearing coverage through a Medicare Advantage plan, your monthly premium gives you access to those benefits. You will not pay anything above and beyond your premium unless you take advantage of those services.
Like most insurance plans, your Medicare Advantage plan will have a deductible. Your coverage will not begin until you have paid your deductible for the year. After that, you may need to pay a copay when you get a hearing exam, hearing aid exam/fitting, or hearing aid(s). That copay may be higher or lower depending on the plan you choose. There may also be a limit on how often you can get hearing aids.
According to the Kaiser Family Foundation, as many as 22% of plans did not have a cost-sharing requirement for hearing aids in 2019 but 60% of plans had a copay ranging from $5 to $3,355. Medicare Advantage plans that do not require you to pay for hearing aids tend to have a higher maximum out-of-pocket limit for the year. It helps to shop It helps to shop around.
For example, in New Hampshire, there are 36 Medicare Advantage plans being offered for 2022. Copays range from $0 to $2,095 for hearing aids. Instead of a copay, some plans require plan holders to pay a coinsurance. Instead of a fixed dollar amount, that means you will pay a set percentage of the cost. Some New Hampshire plans had a coinsurance as high as 40%. Many plans list different rates for in-network and out-of-network services.
NOTE: Rates will vary depending on where you live.
How can I find Medicare plans that cover hearing aids?
If you want to shop for Medicare plans, you can use the Medicare Plan Compare site to get a sense of what plans are available in your area.When you do this, pay close attention to the Extra Benefits section. Here you will find the copays for the different hearing services.
As helpful as Medicare Plan Compare is as a first step, it does not include all the information you will need. What kinds of hearing aids are covered? What brands are covered? What are the plan’s limits on hearing services? You may then want to reach out to the plan directly or find an insurance broker in your area to find out more.
NOTE: Access to hearing aids could change in the future. Recent legislation, known as the Build Back Better Act, made its way to the House Committee on the Budget on September 27, 2021. It has provisions that would add hearing aids to your Part B benefits starting on October 1, 2023. Certain services performed by audiologists would also be covered. All of these services would be subject to the 20% Part B coinsurance. Depending on what happens with the Build Back Better Act, you may need to turn to a Medicare Advantage plan for coverage in the meantime.
Tanya Feke M.D. is a licensed, board-certified family physician. As a practicing primary care physician and an urgent care physician for nearly ten years, she saw first-hand how Medicare impacted her patients. In recent years, her career path has shifted to consultant work with a focus on utilization review and medical necessity compliance. She currently works as a physician advisor at R1 RCM, Inc., where she performs case reviews for hospitals nationwide.
Dr. Feke is an expert in the field, having Medicare experience on the frontlines with both patients and hospital systems. To educate the public about ongoing issues with the program, she authored Medicare Essentials: A Physician Insider Reveals the Fine Print. She has been frequently referenced as a Medicare expert in the media and is a contributor to multiple online publications. As founder of Diagnosis Life, LLC, she also posts regular content about health and wellness to her site at diagnosislife.com.