Understanding the details of Medicare and what it covers can be downright confusing. Commonly, hearing care professionals are asked, "Does Medicare pay for hearing aids?" The short answer to this question is no, but the long answer is more complex.
Medicare, the federal health insurance program, covers people who are 65 or older, as well as younger people with disabilities or serious diseases. However, Medicare does not cover all costs of medical services, which is where the rules get tricky. There are a number of factors affecting coverage, so it is imperative all individuals take the different kinds of coverage available into consideration. Before we answer the hearing aids question, we need to understand what it does and does not cover. If you want to skip to the answer, click down to the section Items not covered by Medicare.
What affects your out-of-pocket costs?
When you are choosing a type of insurance, you should consider your medical needs and your financial resource, and make sure the option you choose will cover you. Ask your doctor or healthcare provider if they will accept Medicare. Not all practitioners, including your trusted doctor, will accept it.
What type of healthcare plan is most pertinent to your health? If you are living with hearing loss, consider a plan that will cover at least a portion of your costs. Medicare Part B will sometimes cover part of a hearing loss treatment. Generally, Medicare will not cover a routine hearing exam, but if you are approved for a diagnostic hearing exam, you may only have to pay 20 percent of the charges.
Medicare will cover services that are considered necessary to treat a disease or condition, such as surgeries, lab tests and doctor visits as well as supplies like wheelchairs and walkers. While there are different rules for people with a Medicare Advantage Plan, you will be under the general coverage of the original Medicare plan.
Medicare Part A: Hospital insurance
- Hospital care
- Nursing home care
- Home health services
- Skilled nurse facility care
Medicare Part B: Medical insurance
Medicare Part B covers two types of services: medically necessary and preventative services. Preventative services include early detection of an illness. Most of these services are provided at no cost for people with Part B coverage.
- Ambulance services
- Durable medical equipment
- Inpatient, outpatient and partial hospitalization for mental illness
- Seeing a second doctor before surgery
- Some outpatient prescription drugs
- Clinical research
Medicare Part C: Medicare Advantage Plans
This plan is a healthcare option that is run by a private insurance company under contract with Medicare. The Advantage Plan usually includes coverage of all parts of Medicare.
Medicare Part D: Drug plan coverage
Medicare prescription drug plans each have a list of available medications. The drugs are separated into different tiers based on your out-of-pocket costs for each. Drugs that are listed in the lower tiers will cost you less than a drug in a higher tier. The drug plans have specific coverage rules laid out that need to be considered as well.
Hospital outpatient drugs: Prescription drugs given in a hospital outpatient setting, which are considered self-administered drugs, are generally not covered by Part B. However, there are certain circumstances when your Medicare drug plan will cover them.
Vaccine coverage: Medicare drug plans must cover all vaccines that are commercially available to prevent illness.
Automatic refill services: As of January 2014, the automatic refill services offered by Medicare has changed to reduce waste. When you need a prescription refilled, prescription drug plans now need approval before sending the medication. However, if you specifically request the prescription, it will be sent out.
Items not covered by Medicare
Before getting Medicare, it is also important to note what is not covered by either plan. If you need any of the services not covered by Medicare, you will have to use other insurance or pay for them yourself.
- Foot care
- Cosmetic surgery
- Hearing aids and fitting exams
- Dental care
- Eye care
- Long-term or custodial care
Screenings covered by Medicare
Medicare covers screening services and preventative tests under the Medicare Part B plan. These include shots for flu, hepatitis B and pneumococcal. In addition, it will cover a yearly wellness visit.
Other services covered by Medicare:
- Abdominal aortic aneurysm screening
- Bone mass measurements
- Cardiovascular disease screenings and behavioral therapy
- Cervical and vaginal cancer screenings
- Diabetes screenings and self-management training
- Glaucoma tests
- HIV screenings
- Prostate cancer screenings
- Sexually transmitted disease screenings and counseling
Medicare Part B also covers health screenings for alcohol abuse, obesity, nutrition therapy and depression.
How to apply for Medicare
Medicare and other insurance
Since Medicare does not cover everything, many people will use Medicare with other, supplemental, health insurance. If you have both Medicare and supplemental insurance, each of these is considered a payer. The first or primary payer will receive the bills first, and send the rest to the secondary payer. The first will pay up to the limits of its coverage and then the second will pay beyond that.
If you have questions about Medicare or other insurance coverage, find a hearing healthcare professional in your area to help you find answers about hearing healthcare and hearing aids.