Does Medicare Cover Audiologist?
First let’s dive into exactly what an audiologist is and does.
Audiologists are health care professionals who specialize in disorders dealing with hearing, balance, and other neural systems. Once a disorder is diagnosed these healthcare providers fit and dispense hearing aids and other types of listening devices if appropriate. Keep in mind that an audiologist does not perform surgery. If you suffer from a hearing issue that requires surgery, then you will need to see an ENT doctor.
Types of Hearing Loss
While hearing loss can come in many forms that can range from minimal to total loss of hearing. There are two broad categories of hearing loss:
- Sensorineural hearing loss – which is when there is usually permanent damage to the inner ear or auditory nerve.
- Conductive hearing loss – occurs when sound waves cannot reach the inner ear. Typically medical treatment or surgery can correct the hearing loss.
As we age, the odds of hearing loss increase. It is estimated that 1 in 3 people between the ages of 65 and 74 suffers from a certain degree of hearing loss. For those older than 75 nearly half has difficulty hearing clearly. This type of hearing loss is often times called Age-Related Hearing Loss but is medically diagnosed as Presbycusis. This type of hearing loss comes on gradually as we get older and it seems to run in families. Additionally this type of hearing loss usually (but not always) occurs in both ears. Once the hearing loss has progressed substantially, many older adults will look to hearing aids as a solution.
What Does Medicare Cover?
So…does Medicare cover audiologist? Medicare will cover diagnostic exams with an audiologist when a healthcare professional such as a physician, clinical nurse specialist, nurse practitioner, physician’s assistant or other approved provider refers you to an Audiologist to determine appropriate medical care for your hearing issue. If this criteria is met then Medicare Part B will generally cover 80% of the approved charges (after the annual Part B deductible has been met) leaving you or your Medicare Supplement to pay the other 20%.
So does this mean that a healthcare professional can refer you to an audiologist for a routine hearing test and Medicare will cover it? No. Medicare does not cover routine hearing tests, hearing aids, or the exams for fitting of hearing aids.
Does a Medicare Advantage plan cover hearing aids?
If you are covered by a Medicare Advantage plan you could possibly have some coverage for hearing aids. While not all plans provide this additional coverage, some do. Many times there are strict limitations on the actual benefits and coverage limits for hearing aids. Some plans may cap out a certain dollar amount they will pay, while other plans may pay a higher amount towards hearing aids, but will limit the purchase to once every few years.
Keep in mind that most Medicare Advantage plans use a network, such as a PPO or HMO. This means that if your plan does actually provide benefits toward hearing aids, you will need to see an audiologist that is part of that plan’s network.
How Else Can You Get Benefits For Hearing Aids?
If you are on traditional Medicare Parts A & B (whether you have a Medicare Supplement or not) you can always purchase stand-alone coverage for hearing benefits. While these plans are not usually sold with just hearing benefits, you actually get 3 areas of coverage with them. This includes dental, vision, and hearing. To find out more about these plans click here.
If you are having hearing issues, your first step should be to schedule a visit with your primary care physician to discuss your concerns. If you have questions about obtaining coverage for possible future hearing issues, then feel free to call us at (800)924-4727 or click on the Get A Quote Now button above.