Hearing aids can be prohibitively expensive and you might find yourself asking why they are not covered by Medicare. To answer the question, we would need to first look at what Medicare is and then look at what hearing care coverage (if any) is provided.
What is Medicare?
Medicare is the federal health insurance program for people aged 65 and older, certain people who are younger with disabilities, and those with permanent kidney failure requiring dialysis or a transplant. Medicare doesn’t cover all medical costs. There are various factors affecting coverage, which you can check on their website, or you can download the official Medicare coverage mobile app, “What’s covered“.
Will Medicare pay for my hearing aids?
Medicare does not pay for hearing aids, as stated on their website: “Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental. Contact the plan for more information.”
Why are hearing aids not covered by Medicare?
According to Elsa Pearson and Austin Frakt, back in 1965 when Medicare was signed into law, it excluded coverage for hearing aids. At the time, hearing aids were considered “routinely needed and low in cost” which suggested that consumers would be responsible for payment. At the time, many seniors didn’t live as long as they do today, and therefore fewer people needed hearing aids due to age-related hearing loss. In addition, there was also little understanding of the link between hearing loss, depression, and social isolation.
Today, the cost of hearing aids can be considerable, and the need for them is widespread, but Medicare still doesn’t cover them. Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) if prescribed by a doctor for use in your home. Hearing aids, unfortunately, don’t meet all the criteria for DME: they are not merely useful to someone who is sick or injured, they are not solely used in your home, and they are not prescribed by a doctor.
Medicare does, however, cover diagnostic hearing tests recommended by a doctor. The “Welcome to Medicare Visit” also requires hearing screening through questioning or a questionnaire, and the Medicare Annual Wellness Visit includes, as a requirement, evaluation using screening questions, a questionnaire, or direct observation. According to Healthy Hearing, over the years, many organizations and legislators have tried to update Medicare to cover hearing, vision, and dental costs for seniors.
The Hearing Loss Association of America reported that in 2019, the House of Representatives voted to expand Medicare to cover hearing aids and related hearing health care services. The House approved the HR 3 bill, which allows the federal government to negotiate prescription drug prices, and to use the savings from lower prices to cover the costs of hearing care (which may include hearing aids), dental and vision health services. HR 3 has yet to be passed by the Senate, so it remains to be seen whether it will successfully become law. Also pending is the Medicare Audiologist Access and Services Act of 2019, a bill “to provide certain coverage of audiologist services under the Medicare program, and for other purposes”.
Lawmakers and advocacy groups are progressing positively concerning hearing aids. However, at this stage, it isn’t clear whether Medicare will make the needed changes to its policies for these devices to be covered in the future.
Original Medicare (Medicare Part A and Medicare Part B)
Currently, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) do not cover hearing aids or related services, such as tests for hearing aid fittings. However, in the future, legislation may change Medicare’s coverage for hearing aids.
Medicare Part A covers in-patient care in a hospital, nursing home care, skilled nursing facility care, hospice care and home health care.
Medicare Part B covers medically necessary and preventative services. While hearing aids are not covered, there is coverage for hearing exams recommended by a doctor to see if medical treatment is required. In this case, you will be required to pay 20% of the cost of services for covered exams, the Part B deductible, and in the case of an outpatient setting, a co-payment to the hospital.
Medicare Part B does cover “some surgically implanted prosthetic devices, including cochlear implants”, and according to Medical News Today, bone-anchored hearing aids (BAHA), which are classified by Medicare as prosthetic devices and not hearing aids.
A BAHA is not the same as a hearing aid. It is a device that is implanted surgically and is only suitable for certain types of hearing loss. The BAHA provides a different way of improving hearing. Sound is transferred to the inner ear via the skull bone instead of the ear canal, thus bypassing the middle and outer ear, known as bone conduction.
Part A or Part B covers surgically implanted prosthetic devices, depending on where the surgery occurs i.e. in an inpatient or outpatient setting. In order for Medicare to pay for your device, you will have to go to a supplier that’s listed with Medicare.
Medicare Advantage (Medicare Part C)
Medicare Advantage is a health insurance plan that is managed by a private insurance company. Medicare Advantage Plans are provided by a private health insurer under contract with Medicare, and usually include all your Part A and Part B benefits.
If you have a Medicare Advantage Plan, there is coverage of most Medicare services through the plan, although your Medicare services are not paid for by Original Medicare.
Types of Medicare Advantage Plans include Preferred Provider Organization (PPO) Plans, Private Fee-for-Service (PFFS) Plans, Health Maintenance Organization (HMO) Plans, Special Needs Plans (SNPs), HMO Point of Service (HMOPOS) Plans, and a Medicare Medical Savings Account (MSA) Plan.
Certain Medicare Advantage plans do cover hearing aids and associated costs e.g. maintenance. The private insurer may also pay for hearing exams. You can contact your plan provider to find out if you have Part C coverage, or if you have additional cover that is not related to Part C.
If you are considering Medicare Advantage, it’s a good idea to compare the benefits of the different plans in order to choose the option that will be most suited to your needs.
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