Unfortunately, when it comes to vision, dental and hearing care, traditional Medicare doesn't offer much coverage for older adults.
If you have supplemental insurance, however, it may pay for some or all of these services, depending on your plan.
What is Medicare?
Medicare is a federal health insurance program that 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 you take the different kinds of coverage available into consideration.
Are hearing aids covered by Medicare?
No. Medicare is very clear about this on their website.
As they explain, Medicare doesn't cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover - like vision, hearing, or dental. Contact the plan for more information.
What about Medicaid?
This depends on your age and your state of residence. All children with hearing loss who are on Medicaid can receive hearing care and hearing aids, anywhere in the U.S. For adults, though, Medicaid coverage for hearing care depends on what state you're in. This page contains state-by-state coverage information for adults.
Does Medicare cover hearing tests?
In some cases, yes, but only if recommended by your primary care doctor or another physician. In other words, you can't go to a hearing clinic without a referral and expect Medicare to pay for it.
Here's how Medicare explains hearing exam coverage: "Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or other health care provider orders them to see if you need medical treatment. You pay 20% of the Medicare-approved amount for your doctor's services for covered exams, and the Part B deductible applies. Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids."
Why doesn't Medicare cover hearing care?
As this clinical review explains, "The Medicare Act of 1965 statutorily excluded coverage of hearing aids under the premise that they were 'routinely needed and low in cost,' suggesting that consumers would be responsible for their purchase." Also, at the time, many seniors didn't live as long as they do today, and so fewer people had age-related hearing loss. There also was little understanding of how important it is to treat hearing loss to reduce depression and social isolation.
Will coverage on hearing aids change?
Many people would like to see Medicare evolve to cover dental, vision and hearing care. A Commonwealth Fund report details the financial and health burdens these gaps place on older adults. The report said:
"Among Medicare beneficiaries, 75 percent of people who needed a hearing aid did not have one; 70 percent of people who had trouble eating because of their teeth did not go to the dentist in the past year; and 43 percent of people who had trouble seeing did not have an eye exam in the past year."
However, so far, no one has been successful at getting changes made to this part of Medicare coverage. In the summer of 2019, several U.S. representatives introduced H.R. 4056, a bill that would require Medicare to pay for certain audiological services. Time will tell if this bill gets passed.
What do all the Medicare 'parts' mean?
Here's a breakdown:
Medicare Part A: Hospital insurance
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.
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. In some cases, the private insurer may pay for hearing exams. You should check with your plan provider if you have Part C coverage. If you also have supplemental coverage not related to Part C, again you should check with your provider.
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.
What other items are not covered by Medicare?
Besides hearing aids and fitting exams, there are many other medical expenses not paid for by Medicare. They include:
What about 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 (this is not a comprehensive list):
Medicare Part B also covers health screenings for alcohol abuse, obesity, nutrition therapy and depression.
How to apply for Medicare
For convenience, you can apply for Medicare on the Social Security website. You can use the online form to sign up for Medicare coverage, even if you are not ready to retire. If hearing loss is affecting your ability to work, you can also looking into Social Security disability benefits.
Medicare and other insurance
If you have questions about hearing loss and how to pay for hearing aid services, a hearing healthcare professional in your area may be able to help you.