Does Medicare cover hearing tests?
In some cases, yes, but only if recommended by your primary care provider or another physician. In other words, you cannot go to a hearing clinic for testing without a referral and expect Medicare to pay for your visit.
Here’s how Medicare explains hearing exam coverage: “Medicare Part B (Medical Insurance) covers diagnostic hearing exams if your primary care provider or physician orders them to see if you need medical treatment. You pay 20% of the Medicare-approved amount for your doctor’s services for covered exams, and the Part B deductible applies. Medicare doesn’t cover routine hearing tests, hearing aids, or evaluations for fitting hearing aids.“
Are hearing aids covered by Medicare?
No. Medicare is very clear about this on their website: “Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover — like vision, hearing, or dental. Contact the plan for more information.”
If there is coverage through an Advantage Plan, it is likely more of a discount program than a covered benefit. In other words, the Advantage Plan contracts with certain providers who agree to lower reimbursement rates — and this may limit access to needed personalization and follow-up services.
What about private insurance coverage?
Some employer-provided plans will cover some or all the cost of diagnostic hearing tests. It is always a good idea to check their websites to see what may be covered. Many companies control their costs through high deductibles, co-payments, and by restricting access to limited providers. If you elect to get your hearing test elsewhere, we are happy to schedule a no-charge consultation to review those results and to discuss treatment options.
What about coverage at Highline Hearing Professionals?
Highline Hearing Professionals is in-network with Medicare Part B, Regence BlueShield, and the State of Washington’s Department of Labor and Industries (L&I).
For medical/diagnostic services:
Medicare Part B: We will submit a claim to Medicare only if you have a current medical referral. If not, we apply a prompt payment discount and collect payment from you at the time of service.
Regence BlueShield: We will submit a claim and collect copayment or remaining balances from you after processing.
State of Washington’s Department of Labor and Industries (L&I): Only with prior approval.
Other Private Insurers (Not Medicare Supplements): e.g., Aetna, Premera, United Healthcare, Cigna, Humana, etc. We will apply a prompt-payment discount and collect payment from you at the time of service. You will receive a statement to submit to your insurance carrier for possible reimbursement or to apply toward your deductible.
For hearing aid purchases:
Our medical biller will check for possible hearing aid benefits on all plans for which we receive complete information. Please provide us with a copy of your card and your date of birth (or the date of birth for the primary policyholder). We can generally let you know within a few days if you have any in-network or out-of-network benefits for hearing aids.
Because you will have a 75-day trial period with your new hearing technology, you should have ample time to assess whether your out-of-pocket costs are warranted given the benefits you experience with better hearing.