Hearing loss is a common issue, particularly among older adults, yet the cost of hearing aids can be prohibitive. Understanding coverage options through Medicare or Medicaid can be challenging, as these programs offer varying degrees of support.
Medicare coverage for hearing aids
Medicare is a federal program offering health insurance for individuals aged 65 or older and certain younger people with disabilities. However, it does not uniformly cover hearing aids. The following outlines Medicare’s approach to hearing-related expenses:
- Original Medicare (Parts A and B): This standard plan does not cover hearing aids or the exams necessary for fitting them. You pay 100% of the cost for hearing aids and exams. However, Medicare Part B covers diagnostic hearing and balance exams if a doctor orders them to determine medical treatment needs. Beneficiaries typically pay 20% of the approved costs for such exams after meeting their deductible.
- Medicare Advantage (Part C): These private insurance plans, an alternative to Original Medicare, often include hearing care benefits such as hearing aids. Coverage details vary widely, including co-pays, frequency limits, and brand restrictions. For example, some plans may cover up to $1,000 per hearing aid every two years, while others might impose tighter limits.
- Medigap: Supplemental insurance plans like Medigap do not extend benefits to services Original Medicare excludes, such as hearing aids. They only help cover out-of-pocket expenses for approved Medicare services.
Medicaid coverage
Medicaid, a state-administered program for low-income individuals, offers more comprehensive options than Medicare, but coverage differs significantly by state. Most states include some provision for hearing aids, especially for children under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Adults may also receive coverage depending on state policies, often with limitations on frequency and cost.
Why Medicare doesn’t cover hearing aids
When Medicare was established in 1965, hearing aids were excluded as they were deemed “low-cost” and “routinely needed.” Modern research, however, has highlighted the critical role of hearing aids in mitigating social isolation and cognitive decline among seniors. Advocates and lawmakers have pushed for expanded coverage, but progress has been slow. Bills like H.R. 4056, introduced to include hearing care, have yet to be enacted.
Alternatives and supplemental options for hearing aids
If you don’t qualify for coverage under Medicare or Medicaid, there are other avenues to explore:
- Over-the-counter (OTC) hearing aids: Since 2022, OTC hearing aids for mild-to-moderate hearing loss have been available without a prescription. They cost less—between $200 and $1,000—but lack the customization and audiologist support of prescription devices.
- Private Insurance: Some private insurance plans cover hearing aids partially or fully. Employers may also offer plans with hearing aid benefits.
- Nonprofits and Discount Programs: Organizations like the Hearing Loss Association of America and state-specific programs provide financial assistance or discounts for hearing aids.
- Health Savings Accounts (HSAs): For those with HSAs, hearing aids are considered a qualified medical expense, enabling tax-free purchases.
Enrollment and choosing the right plan
To optimize your benefits:
- Consider enrolling in a Medicare Advantage plan during the open enrollment period (October 15 to December 7) if you anticipate needing hearing aids.
- For Medicaid, check your state’s coverage policies and eligibility criteria.
- Use Medicare’s Plan Finder to compare Medicare Advantage options, paying attention to the “Extra Benefits” section to identify plans with hearing care coverage.
Costs and financial assistance
The average cost of hearing aids ranges from $1,000 to $4,000 per ear. These costs often include services like fittings, maintenance, and adjustments. For those without adequate insurance coverage, alternative options include:
- Nonprofits and Charities: Organizations like the Miracle-Ear Foundation and the Lions Club International offer assistance to those in need.
- State Assistance Programs: Some states have hearing aid loaner banks or financial assistance programs.
- Employer-Sponsored Insurance: Certain plans may provide partial hearing aid coverage
