What you need to know about insurance for hearing care

HealthMarkets helps you navigate what insurance may cover if you have hearing issues or a need for hearing aids.

 

Are you one of the roughly 37.5 million American adults who has trouble hearing? Keep reading to learn what insurance may or may not cover.

“Out-of-pocket costs for devices and services because of lack of insurance coverage is a reason why people often don’t seek hearing care,” says Catherine Palmer, Ph.D., director of audiology and hearing aids at the University of Pittsburgh Medical Center. With that in mind, we asked Susan Pilch, J.D., about the different types of hearing insurance that are available to help people. She is the senior director of government relations for the American Academy of Audiology.

Contact a licensed insurance agent today at (800) 827-9990, or shop online to find hearing benefits.

Choice #1: Individual (or private) insurance

“Most private insurance plans will cover the cost of a diagnostic hearing exam, but not all currently cover hearing aids,” says Pilch. And most states don’t require insurance companies to cover hearing aids for adults.

Plans that offer hearing aid coverage may do it in a variety of ways. According to Pilch, some plans may:

• Pay a certain amount toward the purchase of hearing aids
• Offer a discount plan if you use a certain network
• Require you to have serious hearing loss before you can get coverage
• Limit you to certain hearing aid models or technology

There are also U.S. Food and Drug Administration–approved over-the-counter hearing aids. They are for mild to moderate hearing loss, and some insurance plans may offer some coverage for those devices, says Pilch. But you may still have to have a certain level of hearing loss for that coverage to apply.

Choice #2: Original Medicare

Let’s say you’re 65 or older and on Original Medicare. That’s Medicare Part A (hospital coverage) and Part B (doctor coverage). Original Medicare may cover certain tests of the hearing and vestibular system, which has to do with balance, if your doctor orders them, says Pilch.

In 2023, Medicare started allowing some people to access certain hearing-related services without their doctor’s order. Hearing aid coverage is a whole different story.

“At this time, traditional Medicare does not cover hearing aids or exams for the purpose of fitting hearing aids,” Pilch says. Routine hearing exams that aren’t related to qualifying medical condition, injury or illness are also not typically covered.

Choice #3: Medicare Advantage (Medicare Part C)

Pilch says that many Medicare Advantage plans offer hearing care services. But the benefits vary widely from plan to plan. “Most plans limit beneficiaries to 1 hearing exam per year,” she says.

But other coverage has different rules. You may need to pay for part of the cost for hearing aids. Or there may be a top dollar amount your plan will pay annually toward hearing aids.

Some good news: Medicare Advantage plans do not require you to get a doctor’s order before seeking the services of an audiologist, notes Pilch. (That’s the type of doctor that can help you with hearing and balance issues.)

If you have a Medicare Advantage plan and are trying to figure out what type of hearing benefit is available to you, you can call a licensed insurance agent today at (800) 827-9990. Or shop online for a plan that has the benefits you want.

Choice #4: Medicaid

State Medicaid programs must offer hearing aid coverage for children, but they don’t have to do so if you are 21 or older. Only some states offer adult hearing aid coverage, and the level of coverage is different from state to state. It’s also often based on how serious your hearing loss is. Plus, Medicaid may not cover hearing aid accessories or repairs.

Choice #5: Supplemental insurance

Some insurance companies offer hearing benefits as part of a supplemental insurance plan. Supplemental insurance plans are separate plans you can buy that help pay for health care costs outside of your health insurance plan.

Bonus: Other ways to help pay for hearing aids

If your insurance plan doesn’t cover the cost of hearing aids, there are some other ways you can pay for them.

• Health account funds. Hearing aids are considered medical devices, so you can use the pretax money you have in your Flexible Spending Account (FSA) or Health Savings Account (HSA) to help pay for the cost.
  • Usually, you sign up for an FSA through your employer, and there’s a specific enrollment period for it. For an HSA, however, you have to have a High-Deductible Health Plan, or HDHP. That’s a type of insurance plan that has a higher deductible (that’s how much money you have to pay before your insurance starts to pay).

• Hearing aid charities. There are many organizations that can help people with the cost of hearing aids. Here are a few to consider:
  • Hearing Aid Project (hearingaiddonations.org): The Hearing Charities of America has compiled a list of national and state resources if you’re in need of hearing-aid financial assistance.
  • Hearing Industries Association (betterhearing.org): This nonprofit provides a list of organizations, government programs and charities that can help cover the cost of hearing care.
  • Help America Hear (helpamericahear.org): Founded in 2004, they provide hearing aids to people with limited financial resources. There is an application process to qualify.

If you are looking for hearing aid benefits available to you, talk to a licensed insurance agent today at (800) 827-9990. You can also compare benefits online at your convenience.