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Although hearing loss affects millions of Americans, determining what Medicare actually covers can be confusing. In many cases, Medicare does cover hearing tests, but there are important limitations and guidelines you’ll want to know, whether you’re helping someone navigate their care or managing your own health. Let’s look at Medicare hearing test coverage and other insurance options.
Yes, Medicare covers hearing tests, but with conditions. Original Medicare Part B used to only cover hearing tests that a physician or healthcare provider ordered to diagnose a medical condition, such as hearing loss related to an illness or injury. [1] However, due to recent changes, patients with Original Medicare can see an audiologist for hearing tests once every 12 months without a physician's order. These tests include those for non-acute hearing conditions, but don’t include tests for imbalance. [2]
However, hearing aids and hearing aid fittings are still not covered under Original Medicare. [3]
Patients with Original Medicare can see an audiologist for hearing tests once every 12 months. Beyond that, Medicare doesn’t set a standard frequency for hearing tests; instead, it depends on medical necessity. If your doctor determines a hearing exam is required to evaluate a potential hearing-related issue, it may be covered. It’s important to read through your individual policy to understand your specific plan.
Schedule an appointment with a nearby audiologist.
In many cases, yes, insurance will cover hearing tests. Both private and public health plans often cover diagnostic hearing evaluations. If you’re not on Medicare, your private health insurance plan may cover hearing tests, especially if they’re considered medically necessary.
However, insurance may exclude routine or preventive hearing screenings and hearing aid fittings, which are often a critical gap in care for some insurance holders.
Plans provided through employers or individual markets can vary widely, so always confirm your coverage before scheduling a test.
Coverage often differs by age group. Many pediatric and young adult health plans offer routine hearing evaluations, [5] but adult coverage is typically tied to a medical need. Some wellness plans now include baseline hearing checks, so it’s worth exploring with your provider.
TRICARE covers hearing tests for its members, with specific stipulations based on their active duty status. For Active Duty members, TRICARE will cover one hearing test per calendar year. [6] Retired members may be eligible for hearing exams, provided their local military hospital or clinic has the availability in their schedule. Hearing exams are covered for children who are dependents at least through the age of 5.
TRICARE may also offer additional benefits for active-duty personnel, retirees, and dependents, depending on the particular plan.
Unaddressed hearing loss can directly impact your overall health and quality of life, so don’t wait to get the answers and coverage you need. While Medicare hearing test coverage may be somewhat limited, depending on your plan and circumstances, there are many paths to affordable care. Whether through a Medicare Advantage plan, private insurance, or other programs, you may have more options than you think.
Amplifon Hearing Health Care connects organizations and their customers with quality care, superior products and an exceptional experience so you can understand your hearing benefits and get the care you need.
Want more information? Contact us for help navigating your hearing health coverage. You can also follow us on LinkedIn for more insights into hearing health news and what’s happening at Amplifon.
Knowing if you have hearing insurance is easy.
Sources
1. Medicare. “Hearing & Balance Exams.” Retrieved from https://www.medicare.gov/coverage/hearing-balance-exams
2. Centers for Medicare & Medicaid Services. “Audiology Services.” Retrieved from https://www.cms.gov/medicare/payment/fee-schedules/physician/audiology-services
3. Medicare. “What’s Not Covered.” Retrieved from https://www.medicare.gov/providers-services/original-medicare/not-covered
4. AARP. “Does Medicare Cover Hearing Tests?” Retrieved from https://www.aarp.org/medicare/faq/does-medicare-cover-hearing-tests/
5. HealthCare.gov. “Preventive care benefits for children.” Retrieved from https://www.healthcare.gov/preventive-care-children/
6. TRICARE. “Covered Services.” Retrieved from https://tricare.mil/CoveredServices/IsItCovered/HearingExams
