Generally, Medicare does not cover routine hearing exams. Medicare covers other approved healthcare costs that are distributed under the different parts. For example, Original Medicare covers inpatient and outpatient hospital and medical expenses. Part A covers services such as hospice care, nursing home care, hospital care, home health services, and skilled nursing facility care. Medicare Part B covers doctor visits, durable medical equipment, ER visits, preventive screenings, and diagnostic tests. Medicare Part D covers prescription drugs, while Medicare Advantage covers the same services as Original Medicare in addition to other services.
Under Original Medicare, you cannot get coverage for routine hearing. It also does not cover hearing aids or exams that are meant for fitting hearing aids. However, in some cases, Original Medicare may cover diagnostic hearing and balance exams.
As mentioned previously, Medicare Advantage provides the same coverage as Original Medicare, but also provides additional benefits. Now, each Medicare Advantage plan will vary in coverage, meaning they won’t all provide the same additional benefits. But, there are some that will include coverage for hearing services.
To get coverage for routine hearing, you will need to enroll in a Medicare Advantage plan. Many Medicare Advantage plans provide coverage for hearing services such as hearing aids, hearing exams, hearing aid fittings, and treatments.
Do keep in mind that some Medicare Advantage plans will also require that you use their in-network providers to receive your care. This means for any hearing care that you receive, you’ll want to make sure it will be provided in your plan’s network and will be covered. A good example of a Medicare Advantage plan that requires its plan members to use their in-network providers is an HMO (Health Maintenance Organization) plan.
If you are under Original Medicare and you need routine hearing coverage, you will pay 100% of the cost as Medicare does not cover hearing care. A hearing test performed by an audiologist can cost up to $250 if you are paying for it out of pocket. However, if your physician prescribes a diagnostic hearing or balance test that is deemed medically necessary, Medicare will cover 80% of the approved costs.
Under Medicare Advantage, the costs of routine hearing coverage vary based on provider, the type of plan, and other factors. If you need hearing aids, there may be additional costs to repair, clean, adjust, or replace the devices.