Medicare and Hearing Aids

Hearing aids are generally not covered under Original Medicare Part A or Part B. Most Medicare recipients can expect to pay 100% of the cost for hearing care and eye care. Only under rare exceptions such as surgery, an accident or when a hearing loss poses a serious health threat is hearing care covered under Original Medicare.

For example, if your hearing is severely damaged in an automobile accident or you are having problems with balance, hearing care may be covered. In cases where hearing care is covered it must be ordered by a Medicare approved doctor, the hearing care must be deemed "medically necessary" and the patient must have Medicare Part B in addition to Medicare Part A. Once all of these qualifications are met the doctor will order a "diagnostic hearing exam" preformed by a Medicare approved hearing specialist. The exams will be covered at the standard 80% rate with the Medicare recipient paying for 20% of the care after they have met their deductible. With a Medigap Plan these costs may be reduced even further.

Hearing aides used to help with hearing are still usually not covered under Original Medicare even if an individual does qualify for diagnostic screening.

Hearing Aid Benefits under Medicare Advantage Plans

Some Medicare Advantage Plans include hearing and eye care as part of the basic wellness coverage. An Advantage Plan is a privately run Medicare approved health plan that can be used in place of Original Medicare.

Advantage Plans are organized along an HMO or PPO provider framework and each plan is organized a bit differently. They provide substantially similar care to Medicare A and B but then they can also include some additional benefits including hearing care. Each company is different and will pay different percentages for hearing care.

Generally, the bulk of regular hearing exams are covered and benefits will include some hearing aid coverage. These plans usually stipulate that a plan member must first get a referral from their doctor to see a hearing specialist. They will also generally require that the patient see certain hearing aid specialists and buy their hearing aids through certain providers in order to qualify for benefits.

Medicaid Hearing Care Benefits

Medicaid is a much more generous program which is funded jointly by the states and the Federal government to provide care to very poor people. Under Medicaid maintenance care like hearing and eye tests are covered. Generally, the cost of hearing aids is also covered.

Choosing the Right Hearing Aid

Most Original Medicare recipients will have to pay for their hearing care and it pays to shop around and find a certified hearing specialist at a good price. Similarly, because hearing aids are not covered it's important to shop around and find the right hearing aid for your hearing problem.

In contrast, Medicare Advantage Plan and Medicaid recipients generally have very restricted choices when it comes to hearing care benefits. Provided they follow the rules, see the approved providers and use the approved providers for hearing aids a portion of care is covered. However, they may not be happy with the results and usually there is very little recourse.