Why Don’t Insurance Companies Cover Hearing Aids?
Understand the complex reasons why health insurance typically doesn't cover hearing aids and explore your options.
Many individuals experience frustration when seeking insurance coverage for hearing aids. These devices represent a significant financial outlay. The process of navigating insurance policies to cover this expense can be complex and frequently results in limited or no coverage. This situation leads to confusion for those who rely on hearing aids to maintain their quality of life.
Understanding Hearing Aid Insurance Coverage
Standard health insurance plans often categorize hearing aids differently than other medical devices or essential healthcare services. Many traditional health insurance plans, including employer-sponsored ones, exclude hearing aids from coverage or offer only limited benefits. Insurers cover diagnostic services, such as hearing exams performed by a physician or audiologist, to determine the presence and extent of hearing loss. However, the actual hearing aids themselves are treated as non-essential health benefits or assistive devices rather than direct medical treatment for an illness. This distinction means that while the services leading to a hearing aid recommendation might be covered, the device itself is not.
When coverage is available, it is limited, with plans paying a specified amount that may apply per ear or for the entire purchase. This benefit may renew after several years, every three to five years. Some plans may also require that hearing aids be purchased from a contracted provider or through a third party, which can limit choices to specific devices or manufacturers.
Factors Shaping Coverage Decisions
Insurance companies’ decisions regarding hearing aid coverage are influenced by several factors, including how these devices are classified. Hearing aids are regulated by the Food and Drug Administration (FDA) as Class I or Class II medical devices. However, they are not classified as “durable medical equipment” (DME) under current Medicare and Medicaid policies, but rather as routine hearing care, which impacts coverage. Durable medical equipment includes items that are long-lasting, used for a medical purpose, and not useful in the absence of illness or injury, such as wheelchairs or oxygen concentrators.
A significant influence on coverage is the absence of a federal mandate requiring private insurance to cover hearing aids. While some states have implemented their own mandates, these vary widely in scope and limitations. Many state mandates primarily cover hearing aids for children, with a smaller number extending coverage to adults. Even when adult mandates exist, they come with specific financial caps and may not apply to self-insured employer plans.
The substantial cost of hearing aids is another primary reason insurers are hesitant to provide comprehensive coverage. Given the average cost per device, providing full coverage for a large number of policyholders, particularly in an aging population with increasing demand, presents a significant financial burden for insurers. Many insurers historically view hearing aids as a “lifestyle” or “quality of life” improvement rather than a life-saving or disease-treating intervention. This perception contributes to the classification of hearing aids as elective devices, making them less likely to be covered by standard health insurance policies.
Alternative Assistance and Funding
When private insurance coverage for hearing aids is insufficient or unavailable, several alternative avenues can help manage the costs. Medicare, the federal health insurance program for individuals aged 65 or older and certain younger people with disabilities, does not cover hearing aids or exams for fitting them under Original Medicare (Parts A and B). However, Medicare Part B does cover medically necessary diagnostic hearing and balance exams when ordered by a doctor. Some Medicare Advantage (Part C) plans offer additional benefits, which can include varying levels of coverage for hearing aids, but this coverage is plan-specific and may have limitations on frequency or dollar amounts.
Medicaid, a joint federal and state program for low-income individuals and families, offers coverage that varies significantly by state. All states are required to cover hearing aids for children under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. For adults, however, Medicaid coverage for hearing aids is optional for states, leading to considerable differences, with many states providing limited or no coverage.
Eligible veterans may receive comprehensive hearing aid coverage through the Department of Veterans Affairs (VA). The VA provides hearing aids, along with related services such as repairs and batteries, at no charge to veterans who meet specific eligibility criteria. This benefit can also extend to veterans with hearing impairment severe enough to interfere with their participation in medical treatment or daily living.
Beyond government programs, individuals can explore other financial strategies. Hearing aids and related expenses, such as batteries, repairs, and even transportation to care appointments, are considered deductible medical expenses by the Internal Revenue Service (IRS). These costs can be itemized on a tax return if the total qualified medical expenses exceed 7.5% of one’s Adjusted Gross Income (AGI).
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) offer another pre-tax method to pay for hearing aids. Hearing aids, batteries, and repairs are qualified medical expenses for both types of accounts. HSAs are associated with high-deductible health plans, and funds roll over year to year. FSAs are employer-sponsored and have a “use-it-or-lose-it” rule, requiring funds to be spent within the plan year. Non-profit organizations and hearing aid manufacturers may also offer assistance programs or discounts to help reduce the financial burden.