Although Medicare covers a wide range of benefits, there is also a list of services and items that it does not cover. Some of these items include cosmetic surgery, eyeglasses, hearing exams, hearing aids, and exams for hearing aid fittings.
In certain rare instances, however, you may obtain some limited coverage for a hearing examination under Medicare Part B, provided that the exam has been ordered by your doctor or other health care professional and that the exam was ordered based on a need for other medical treatment.
Does Medicare Cover the Cost of Hearing Exams and Hearing Aids?
Typically, Medicare will not cover the cost for routine hearing exams, hearing aids, or the exams that are needed for the fitting of hearing aids. Medicare Part B will, however, cover some costs for diagnostic hearing and balance examinations.
These costs will be covered under Medicare Part B, provided that your doctor or other health care provider has ordered these exams in order to determine whether or not you are in need of medical treatment.
For example, your doctor may order a hearing examination for you due to a hearing loss from a recent injury or illness. In this case, this diagnostic hearing test would be covered by Part B of Medicare.
What Costs Are Covered for Hearing Exams and Hearing Aids?
Typically, you will be responsible for paying 100 percent of the cost of the routine exams and the hearing aids. This is because Original Medicare (Medicare Parts A and B) does not cover routine hearing exams or hearing aids.
However, under the circumstances where these items are covered, you will only be responsible for paying 20 percent of the Medicare-approved amount of the doctor’s services for covered exams. In addition, you will also be responsible for paying the Medicare Part B deductible. Should these services be covered in a hospital setting, you will also be responsible for paying the hospital copayment amount.
Medicare Coverage for Audiology Services
According to Medicare, audiology services are defined as being hearing and balance assessments that are performed by a qualified audiologist, physician, a nurse practitioner, or by a clinical nurse specialist.
Medicare’s coverage for such services are essentially determined based upon the reason that the exams were performed, rather than on your condition or your diagnosis. In addition, these services are limited to the evaluation of your actual hearing and balance. Therefore, your treatment, rehab, or further assessment are not recognized by Medicare when performed independently.
The services that are recognized by Medicare include the following:
Evaluating the cause of your hearing disorder or balance
Evaluating any suspected change in your hearing or balance
Determining the effect of surgery or treatment, or of any medication that you are taking
Reevaluating to follow up with regard to any changes in your hearing or balance
Failing of a screening test (even though screening tests are not covered by Medicare)
Diagnostic analysis of cochlear or brainstem implant and programming
Audiologic diagnostic tests both before and after the implantation of auditory prosthetic devices
While the services that you receive for the purpose of hearing aid evaluation and fitting will not be covered by Medicare, if a doctor refers you to an audiologist for testing that is related to hearing loss, tinnitus, ear disease, balance disorder, or an ear injury, then the testing services should be covered by Medicare – even if the result is the prescription of a hearing aid.
How to Obtain Medicare Coverage for Hearing Exams and Hearing Aids
While Original Medicare (Medicare Part A and Part B) does not typically cover the cost of hearing exams and hearing aids, you may be able to obtain coverage for these items and services through a Medicare Advantage (Medicare Part C) plan. Medicare Advantage plans typically offer services that are not always included through Original Medicare. These may include coverage for hearing exams and hearing aids.