Understanding Hearing Coverage: Medicare vs. Medicare Advantage vs. Supplemental Plans
If you're navigating the world of Medicare and trying to understand what’s covered when it comes to your hearing health — you’re not alone. With terms like Medicare Advantage, Supplemental Plans, and Traditional “Red, White & Blue” Medicare flying around, it can be hard to know exactly what’s covered — especially when it comes to diagnostic hearing tests and hearing aids.
Let’s break it down so you can make informed decisions about your care or help guide someone you love.
What Does Traditional Medicare Cover for Hearing?
Per CMS “Medicare covers and pays for audiology services based on the reason the tests are ordered or directly accessed, as appropriate, rather than by the patient’s diagnosis or condition” (1). Traditional Medicare consists of Part A (hospital insurance) and Part B (medical insurance).
✅ Diagnostic Hearing Test
Medicare Part B does cover diagnostic hearing and balance exams if your physician or audiologist orders them to determine whether you need medical treatment (like surgery or other interventions). You’ll typically pay:
20% of the Medicare-approved amount (after the Part B deductible)
Possibly a facility fee if done in a hospital setting
📌 Important Facts:
Medicare ONLY pays if the test is medically necessary — for example, to evaluate and diagnosis hearing loss, tinnitus, or dizziness tied to a medical condition (3).
If you are receiving In-Home Rehabilitation services, your Part B (medical insurance) coverage is suspended by Medicare and you will be liable for the FULL balance for any services received.
If you are on Hospice, your Part B (medical insurance) coverage is suspended by Medicare, as you have decided not to proceed with lifesaving treatments, and you will be liable for the FULL balance for any services received.
Once every 12 months a patient can see an audiologist without an “order” aka “referral” from their physician, for specific diagnostic tests; excluding testing for the purpose of sudden hearing loss, acute infection, and/or acute dizziness symptoms.
❌ Hearing Test for fitting/adjusting hearing aids
Per CMS “Medicare doesn't cover hearing aids or exams for fitting hearing aids.” (2, 3)
❌ Hearing Aids
Traditional Medicare does not cover:
Hearing aids - Per CMS “You pay 100% of the cost for hearing aids and exams.” (2)
Exams for fitting hearing aids (3)
This means if you need hearing aids, you’ll be paying 100% out-of-pocket — unless you have other coverage.
✅ COCHLEAR IMPLANT/S, Bone anchored hearing aids (BAHA), and Auditory brainstem implants (ABI)
Traditional Medicare does cover “specific devices that replace the function of the middle ear, cochlea, or auditory nerve as prosthetic devices including auditory osseointegrated, cochlear, and auditory brainstem implants” (1).
Medicare Advantage Plans (Part C)
Medicare Advantage (MA) plans are private insurance plans that combine Part A and Part B (and often Part D for prescriptions), and they often offer “extras” not covered by Traditional Medicare.
✅ Diagnostic Hearing Tests
Most MA plans will cover diagnostic hearing tests in the same way as Traditional Medicare. However, depending on your plan, a prior authorization might be required OR who you can see may be restricted to providers who are “In Network” or “participating providers”.
✅ Hearing Aids
Many Medicare Advantage plans do offer some coverage for hearing aids — HOWEVER:
The “coverage” is often only a “discount” on devices; not a true benefit in which your insurance pays a portion of the cost.
MA plans often have a maximum dollar amount they will pay towards hearing aids (e.g., $500–$1,000/year). Any amount over their max will be your responsibility to pay for.
MA plans limit who you can see to receive services and care. Which means you might not get the care you need.
MA plans sometimes restrict the hearing aid technologies you can purchase. Which means you might not get the technology you need to hear your best.
📌 Important Facts:
MA plan details vary a lot between plans — including which providers you can see, whether fitting and follow-up visits are covered, and how often you can replace hearing aids.
Only “basic” or “minimal” services are covered by the plans, necessitating Out-of-Pocket costs for additional appointments.
Patients who want Gold Standard Care, or Best Practices, to ensure they are hearing their very best with their hearing aids, will have to pay for those additional services. Purchasing directly through a provider’s office, without utilizing their insurance “coverage”, will save patient’s money over the next 3-5 years.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans are additional insurance policies that help pay for the out-of-pocket costs under Traditional “Red, White & Blue” Medicare, such as: Deductibles, Copays, and Coinsurance.
✅ Diagnostic Hearing Tests
If you have a Medigap plan along with Traditional Medicare, your out-of-pocket costs for diagnostic hearing tests are likely covered, depending on your plan.
📌 Important Facts:
Not all services completed during a hearing evaluation are covered by Traditional Medicare.
Any services not covered by Medicare, typically are not covered by the supplemental plan; although this varies depending on the supplemental plan.
❌ Hearing Aids
Just like Traditional Medicare, Supplemental plans do not cover hearing aids or hearing exams for the purposes of fitting hearing aids (routine exams).
✅ COCHLEAR IMPLANT/S, Bone anchored hearing aids (BAHA), and Auditory brainstem implants (ABI)
Medicare Supplemental plans typically will cover Cochlear Implants, BAHA, and ABI, so long as Traditional Medicare covers them. It is important to note, surgical procedures which do not follow Medicare Guidelines for candidacy (aka, “off label”) are NOT covered by Medicare or Supplement plans.
💡 Final Thoughts
If hearing loss is affecting your life, understanding your Medicare coverage options is key.
Traditional Medicare is your BEST option for diagnostic testing and accessibility to see the provider YOU want to see — the cost of hearing aids is completely out-of-pocket.
Medicare Advantage plans may have hearing aid coverage — but the fine print matters and can significantly impact the quality of care and/or devices you receive.
When comparing plans, ask:
Do I have to first meet my deductible?
What is the maximum amount per year the insurance pays?
Is the coverage a funded (insurance pays), un-funded (patient pays), or discount program (patient pays)?
Are follow-up visits covered? Are the type of services restricted?
Can I choose my own audiologist or hearing aid provider?
📞 Pro tip: Contact your audiologist — they work with Medicare and private insurers and can guide you through plan options and help verify benefits.
Need Help Navigating Hearing Coverage?
We’re here to help. Whether you’re scheduling a diagnostic test or considering hearing aids, Lake Medical Hearing Center can help clarify your benefits and work with your insurance provider to maximize your coverage. Call (352) 483-4327.
References:
(1) - https://www.cms.gov/medicare/payment/fee-schedules/physician/audiology-services
(2) - https://www.medicare.gov/coverage/hearing-aids
(3) - https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf (page 80, paragraph 7 & 8)
