Does Medicare Cover Audiology Services?

Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, often raises questions regarding its coverage of audiology services. Understanding what Medicare does and does not cover is important for beneficiaries seeking hearing care. The program’s design includes specific provisions for diagnostic services, while generally excluding routine care and devices like hearing aids, prompting many to consider their options for comprehensive coverage.

Covered Audiology Services

Medicare Part B (Medical Insurance) covers audiology services when they are considered medically necessary diagnostic tests. These services are typically covered when a doctor or other healthcare provider orders them to determine if medical treatment is needed for a suspected hearing or balance problem. For example, if a beneficiary experiences sudden hearing loss, tinnitus (ringing in the ears), or dizziness, Medicare Part B may cover diagnostic exams such as audiometry or tympanometry to identify the underlying cause.

These covered tests aid in the diagnosis and treatment of an illness or injury, not for routine screening or general health maintenance. Medicare defines audiology services as hearing and balance assessments furnished by a qualified audiologist, which would otherwise be covered if provided by a physician. These diagnostic services are paid under the Physician Fee Schedule or, if in a hospital outpatient setting, under the Outpatient Prospective Payment System.

Non-Covered Hearing Services

While Medicare Part B covers medically necessary diagnostic audiology services, it generally does not cover routine hearing exams or the purchase, fitting, or repair of hearing aids. Beneficiaries are typically responsible for the full cost of these items and services. Routine exams and hearing aids are not considered medically necessary for the diagnosis or treatment of an illness or injury, but rather for enhancing quality of life.

Even if a doctor recommends a hearing aid, Original Medicare (Parts A and B) does not provide coverage for it. This also applies to exams specifically conducted for the purpose of prescribing, fitting, or changing hearing aids. Therefore, individuals relying solely on Original Medicare will bear the entire financial burden for these types of hearing care needs.

Accessing Services

To access covered audiology services, a Medicare beneficiary typically needs a physician’s order or referral. This order from a primary care physician or specialist is usually required for diagnostic tests to be covered by Medicare. However, for dates of service on or after January 1, 2023, Medicare allows direct access to audiologists for certain diagnostic tests for non-acute hearing conditions once every 12 months, without a physician’s order.

When seeking an audiologist, beneficiaries should ensure the provider accepts Medicare assignment. This means the audiologist agrees to accept the Medicare-approved amount as full payment for covered services. Beneficiaries can use resources such as the Medicare “Find & Compare” tool on Medicare’s official website to locate qualified audiologists who participate in Medicare.

Costs Associated with Audiology Care

For covered audiology services, beneficiaries are responsible for out-of-pocket costs under Medicare Part B. The annual Part B deductible must be met; in 2025, this is $257. After the deductible is satisfied, Medicare pays 80% of the Medicare-approved amount for the covered services.

The beneficiary is responsible for the remaining 20% coinsurance when the audiologist accepts Medicare assignment. While Original Medicare follows these rules, Medicare Advantage Plans (Part C) may have different cost-sharing structures and often offer additional benefits for hearing care, including coverage for routine exams and hearing aids, which Original Medicare does not.