Does Medicare Cover Routine Hearing Exams?
Medicare does not cover routine hearing exams, hearing aids, or exams for fitting hearing aids. You pay 100% for routine hearing aids and exams.
Medicare only covers hearing and balance exams if your doctor or other health care provider orders the exams. Tests help to diagnose hearing loss due to injury or illness or certain conditions like vertigo.
Here is what you want to be careful of. For a particular medical condition, your doctor or your doctor’s assistant may suggest that you need a test or service that Medicare may not cover or pay for. If this occurs, you may have to pay some or possibly all the cost of that test or service. This is true even if you have a Medicare Supplement Plan. (Medicare Supplement plans only pay their portion of the medical bill after Medicare pays. If Medicare pays nothing, neither will you Medicare Supplement Plan.)
No-one wants a surprise bill.
You need to be doubly careful if doctor or doctor’s assistant gives you an Advance Beneficiary Notice (ABN), requiring your signature. That’s what a Provider does when he thinks your service may not or probably won’t be covered by Medicare. It’s essentially a Waiver of Liability. Medicare may not pay anything because they deem the service or test not medically necessary. Again, if they don’t pay, neither will your Medicare Supplement Plan. So, be sure you ask your doctor if the test/service is medically necessary and covered by Medicare.
You will no longer be on Original Medicare if you have a MAP (Medicare Advantage Plan). Sometimes MAPs offer extra benefits that Original Medicare doesn’t cover such as benefits for hearing, dental or vision. Some plans offer these as a no cost benefit in addition to the benefits required by Medicare. Talk to one of our Medicare specialists here at Health Benefits Associates to find which Medicare Advantage plans offer free or reduced-price hearing benefits. It may be that there is a Medicare Advantage Plan the meets your needs better than the one you currently have. As you age, you should review the benefits of your MAP every year to see if there is one that better meets your changing needs, including prescriptions.
Medicare is considering a proposal to include a $25 charge (premium) to Medicare Beneficiaries to cover hearing aids (bundled with Vision & Dental coverage). Also, Congress was presented with the Over-the-Counter Hearing Aid Act of 2017. This is a bill that proposes Medicare cover over-the-counter, inexpensive hearing aids. Current OTC devices are not considered hearing aids as they are not regulated by the Food and Drug Administration.
Let us know how we can assist you with your coverage for benefits that include a hearing exam. As your health insurance broker, we can assist you with your enrollment for no extra cost.