How Often Does Medicare Cover Hearing Tests?
Navigate the complexities of Medicare coverage for hearing tests and services. Discover what's covered, what's not, and your potential costs.
Medicare is a federal health insurance program that provides coverage for millions of Americans, primarily those aged 65 or older, along with certain younger individuals with disabilities. Understanding what Medicare covers, particularly for services like hearing tests, can be complex due to the different parts of the program and varying coverage rules. While Medicare offers broad healthcare coverage, benefits for hearing-related services often depend on the specific type of Medicare plan an individual has.
Original Medicare Coverage for Hearing Services
Original Medicare, consisting of Part A (Hospital Insurance) and Part B (Medical Insurance), has specific rules regarding hearing services. Generally, Original Medicare does not cover routine hearing exams or hearing aids.
However, Original Medicare Part B may cover diagnostic hearing and balance exams when a doctor orders them to diagnose or treat a medical condition. For instance, if you experience symptoms like vertigo, dizziness, or hearing loss linked to an underlying medical condition, a diagnostic exam to investigate these symptoms would likely be covered. These medically necessary diagnostic tests can be performed as often as needed to manage the specific medical condition.
While standard hearing aids are not covered, Part B may cover surgically implanted devices such as cochlear implants or bone-anchored hearing aids (BAHAs) if they are deemed medically necessary. These types of devices are considered prosthetics rather than traditional hearing aids.
Medicare Advantage Plans and Hearing Benefits
Medicare Advantage Plans, also known as Part C, are offered by private insurance companies approved by Medicare. These plans must cover everything that Original Medicare (Parts A and B) covers. Beyond this mandatory coverage, Medicare Advantage plans often provide additional benefits that Original Medicare does not, including routine hearing exams and allowances for hearing aids.
Many Medicare Advantage plans offer supplemental benefits such as routine hearing exams, often on an annual basis. These plans may also provide allowances or discounts towards the purchase of hearing aids. For example, some plans might offer a set dollar amount for hearing aids every few years, or reduced copayments for devices. In 2025, a significant majority of Medicare Advantage plans, over 97%, offer some level of hearing benefits.
The specific hearing benefits, including the scope of coverage, cost-sharing, and any limitations, vary widely among different Medicare Advantage plans, providers, and geographic locations. It is important for individuals to review the plan’s Summary of Benefits or Evidence of Coverage document to understand the exact details of their hearing benefits. Some plans may impose annual benefit caps or restrictions on the brands or providers that can be used.
Understanding Out-of-Pocket Costs
The out-of-pocket costs for hearing services depend on whether you have Original Medicare or a Medicare Advantage plan. For diagnostic hearing and balance exams covered under Original Medicare Part B, you are responsible for certain costs. In 2025, the annual Part B deductible is $257. After meeting this deductible, you typically pay 20% of the Medicare-approved amount for the service.
If the diagnostic exam takes place in a hospital outpatient setting, there might be an additional hospital copayment. There is no yearly limit on out-of-pocket costs under Original Medicare unless you have supplemental coverage like Medigap.
Out-of-pocket costs under Medicare Advantage plans vary considerably by plan. These plans may have their own deductibles, copayments, or coinsurance amounts for both covered services and additional benefits like routine hearing exams or hearing aids. For example, a plan might have a fixed copayment for a routine hearing exam or a specific copayment for hearing aids. The maximum out-of-pocket limit for Medicare Advantage plans in 2025 is $9,350 for in-network services, though individual plans can set lower limits. It is important to consult your plan’s specific documents to understand the financial responsibilities for any hearing-related services.