Financing Care

Medicare vs Medicaid: What’s the Difference?

Learn how Medicare, Medicaid, and private insurance differ so you can maximize your benefits.

Last update on Dec, 22, 2025

Understanding your hearing health benefits can be confusing, especially when it comes to the difference between Medicare vs Medicaid coverage. From hearing exams and diagnostic testing to devices like hearing aids, it’s sometimes difficult to tell what’s actually covered. To further complicate matters, coverage can vary not just by insurance type, but by the specific plan you’re enrolled in and where you live.

This guide is designed to help you understand how Medicaid and Medicare vs other health insurance plans work for hearing aids, hearing tests, and more. By knowing what your plan may or may not include, you can make informed decisions about your hearing health and get the most from your benefits.

Whether you’re currently comparing coverage, considering a hearing test, or looking at treatment options, Amplifon Hearing Health Care can help you navigate your hearing health journey.

Check your insurance benefits today to see how much coverage you currently have.

Understanding the Medicare vs Medicaid Difference

The main differences between Medicare and Medicaid are who qualifies for coverage and what services are included.

When it comes to Medicare vs Medicaid, eligibility is based on factors such as:

Age
Income
Health conditions
Whether you have a disability.

When comparing Medicaid vs Medicare for seniors and people with disabilities, note that you may be dually eligible if you meet the requirements for both.

What’s covered depends on the type of plan you have and, for Medicaid specifically, the state you live in.

Medicare

Medicare is a federal healthcare program for people 65 years of age and older, as well as people under 65 who have a qualifying disability or end-stage renal disease (ESRD). As a federal program, benefits are the same no matter where you live. However, your benefits will vary depending on which parts of Medicare you have and whether you have supplemental coverage. [1]

Part A (Hospital Insurance) covers inpatient care you receive at hospitals or skilled nursing facilities, as well as in-home care or hospice care.
Part B (Medical Insurance) covers doctor’s appointments, outpatient care, preventative care such as screenings, home health care, and durable medical equipment (DME) like wheelchairs or walkers.
Part D (Drug coverage) helps you pay for prescription medications.

When you have Parts A and B, this is referred to as Original Medicare. You must add Part D to receive drug coverage. You may also add Medicare Supplemental Insurance, also known as Medigap, to cover services that are not offered by parts A, B, and D.

As an alternative to government-provided Medicare, you can obtain a Medicare-approved plan from a private insurer. This is known as Part C or Medicare Advantage. These plans “bundle” the benefits you would receive with Parts A, B, and often D.

While plans mirror the benefits of government-provided Medicare, they have different out-of-pocket costs and can provide extra benefits not included with Original Medicare. [2]

Medicaid

Medicaid is a joint federal-state program that provides coverage for low-income families, pregnant women, seniors, and people with disabilities. It is designed to make services accessible for people who might not be able to afford healthcare without Medicaid.

Because each state has its own Medicaid program, the types of coverage and costs will vary depending on where you live. Medicaid covers hearing aids for those under 21 in all 50 states, and 30 states require that commercial insurance covers children's hearing aids. However, adult hearing coverage varies, which means you’ll want to do your own research to understand coverage.

While Medicaid is administered at the state level, the program follows federal requirements. [3]

Check out this state-by-state list of Medicaid programs.

Medicare vs Medicaid Coverage for Hearing Health

Now that you know the main differences between Medicare and Medicaid, we can look at how these plans relate to hearing health care.

Original Medicare

Original Medicare (Parts A and B) does not cover hearing aid fittings or hearing aid devices. You must pay for these out of pocket.

Medicare Part B does cover diagnostic hearing exams if medically necessary.

Medicare will cover one audiology hearing evaluation annually without a physician referral. [5] These visits are subject to deductibles and copays and are not classified as “preventive” screenings.

Medicare Advantage

Hearing exams, fittings, and devices are often covered by Medicare Advantage plans, which usually offer broader coverage than Original Medicare. However, it will vary based on your individual plan.

Medicaid

States are required to provide all preventative and diagnostic hearing care and treatment for children 21 through the Early and Periodic Screening,

Diagnostic and Treatment (EPSDT) mandate. [6]

Even with the mandate, states can determine their own Medicaid policies, as long as they align with federal requirements. Coverage for adults is not federally mandated, but many states offer at least some hearing benefits. [7]

Other Health Insurance

Private health insurance coverage will vary widely, and benefits will depend on your individual plan.

Some states require private plans to offer at least partial coverage of hearing aids for adults, while even more states have mandates requiring hearing aid coverage for children (those under 21).

Even with state mandates, coverage levels vary. [8] Check with your state insurance commissioner for the most up-to-date legislation, as laws are changing rapidly.

Make the Most of Your Hearing Benefits

Despite how important your hearing health is, insurers don’t always include hearing exams and devices. While many state and federal insurance policies are making progress in offering more coverage, it’s still confusing to understand the nuances of Medicare, Medicaid, and private insurance.

Understanding what your plan covers is key to accessing the care you need, from routine hearing exams and balance tests to hearing aid fittings and devices. Amplifon Hearing Health Care can help you navigate through the coverage you need so you can prioritize your hearing health.

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Sources:

1. Centers for Medicare & Medicaid Services. (2024). Overview of Medicare.

2. Medicare. Parts of Medicare.

3. Medicaid. Medicaid.

4. Medicare. Hearing and Balance Exams.

5. Centers for Medicare & Medicaid Services. (2024). Audiology Services.

6. Medicaid. (2024). Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements.

7. Kaiser Family Foundation. Medicaid Benefits: Hearing Aids and Other Hearing Devices.

8. National Library of Medicine. (2022). Understanding State-Level Advocacy: A Guide for Hearing Healthcare Professionals.