What This Article Covers
Medicare coverage: What Original Medicare does and doesn't cover, Medicare Advantage hearing benefits, cost ranges and plan variations
Medicaid coverage: State-by-state differences, adult vs. pediatric coverage, eligibility requirements and application process
Dual eligibility: How Medicare and Medicaid work together, special benefits for those who qualify for both programs
Next steps: How to check your specific benefits, compare plans, and access coverage you're entitled to
You're sitting at your kitchen table, trying to make sense of the Medicare handbook that arrived in the mail. Your audiologist said you need hearing aids—both ears, $5,000 total—and you're on a fixed income. The handbook is 200 pages of dense text, and after an hour of searching, you still can't find a clear answer about hearing aid coverage.
You call Medicare directly. The representative confirms what you were afraid to hear: "Original Medicare doesn't cover hearing aids." Your heart sinks. The hearing aids would cost nearly three months of your Social Security income.
But here's what that representative might not have told you: 54% of Medicare beneficiaries are enrolled in Medicare Advantage plans, and 97% of those plans offer some hearing benefits. The landscape is complex, coverage varies widely, and understanding your options—or changing your plan during open enrollment—could save you thousands of dollars.
Understanding Original Medicare (Parts A & B)
Let's address the disappointing news first, then move to where opportunities actually exist.
What Original Medicare Does NOT Cover
Hearing aids: Original Medicare has explicitly excluded hearing aids from coverage since 1965. This is a statutory exclusion written into the Medicare law itself. As of October 2025, approximately 29 million Americans are enrolled in Original Medicare without hearing aid coverage.
Routine hearing exams for fitting hearing aids: Medicare Part B doesn't cover hearing tests performed solely for the purpose of fitting hearing aids.
Earwax removal (unless causing hearing loss): Routine earwax cleaning is not covered.
Critical Medicare Limitation
If you have Original Medicare Parts A and B—without a Medicare Advantage plan—you will pay 100% of hearing aid costs out-of-pocket. There are no exceptions, no appeals that will change this, and no coverage for the devices themselves or fitting services.
This affects your decision-making: If hearing aids are in your future and you're approaching Medicare enrollment or annual open enrollment, comparing Medicare Advantage plans is essential.
What Original Medicare DOES Cover
While hearing aids aren't covered, Medicare Part B does cover some hearing-related services:
Diagnostic hearing and balance exams when ordered by a physician to diagnose a medical condition (not for fitting hearing aids). Medicare pays 80% of the approved amount after you meet your Part B deductible ($257 in 2025). You pay the remaining 20% and any deductible amount.
Cochlear implants when surgically implanted and deemed medically necessary. This includes the device, surgery, and mapping sessions. Average Medicare-covered cochlear implant cost to beneficiary: approximately $7,057 out-of-pocket (includes deductibles, copays, coinsurance) out of total costs of $50,000-$100,000.
Bone-anchored hearing aids (BAHAs) when surgically implanted and medically necessary (typically for conductive hearing loss or single-sided deafness).
Treatment for medical ear conditions: Infections, tumors, Meniere's disease, and other diagnosed medical problems are covered under standard Medicare benefits.
Medicare Advantage (Part C): Where Coverage Exists
This is where the picture brightens considerably. Medicare Advantage plans are private insurance plans that cover everything Original Medicare covers—plus additional benefits, including hearing.
Medicare Advantage Hearing Benefits: The Numbers
97% of Medicare Advantage plans offer some level of hearing coverage in 2025. This represents a significant benefit improvement over the past decade.
34.1 million Americans are enrolled in Medicare Advantage (54% of all Medicare beneficiaries), giving the majority of Medicare recipients potential access to hearing benefits.
Coverage varies widely:
- Allowance models: $500-$2,500 per ear every 1-3 years
- Copay models: Fixed copays of $699-$999 per ear for network devices
- Hybrid models: Tiered copays based on technology level ($0 for basic, $699 for advanced, $999 for premium)
- Some plans cover one aid, others cover two
- Frequency limits: Annual, biennial, or every 3-5 years
Average out-of-pocket cost for Medicare Advantage enrollees with hearing benefits: $1,820 per hearing aid—a 21% savings compared to no coverage.
Major Medicare Advantage Providers and Their Hearing Benefits
UnitedHealthcare: Broad selection of hearing aids through network of 6,500+ locations nationwide. Benefits vary by plan, typically including 3-year manufacturer warranty and trial periods.
Humana: Two-tier system:
- "Advanced" level: $699 copay per ear per year
- "Premium" level: $999 copay per ear per year
- Annual hearing exams at $0 copay
Aetna: Partners with NationsHearing; coverage up to $2,000 per ear. One routine hearing exam per year included.
Kaiser Permanente, BCBS, Cigna, and regional plans: Most offer hearing benefits through third-party administrators (TruHearing, NationsHearing, Amplifon). Coverage amounts and frequency vary significantly by specific plan.
Medicare Advantage Open Enrollment
October 15 - December 7 each year: This is your window to switch from Original Medicare to Medicare Advantage, or to change Medicare Advantage plans. If hearing aids are in your near future, this is when you can access hearing benefits.
Use the Medicare Plan Finder at Medicare.gov to compare hearing benefits across all available plans in your area. Filter specifically for hearing coverage amounts and network providers you prefer.
Important Medicare Advantage Considerations
Network restrictions: Most Medicare Advantage hearing benefits require you to use specific providers in their network (TruHearing, NationsHearing, Amplifon). This may limit your choice of audiologist or hearing aid models.
Prior authorization: Many plans require prior authorization before coverage is approved. This can add 2-4 weeks to your timeline.
Technology level restrictions: Some plans only cover basic or mid-level technology. Premium features (Bluetooth, rechargeability, advanced noise reduction) may require additional out-of-pocket payment.
Geographic availability: While 99%+ of Medicare beneficiaries have access to at least one Medicare Advantage plan with hearing benefits, the quality and comprehensiveness of those benefits varies by region.
Medicaid: State-by-State Coverage Landscape
Medicaid is a joint federal-state program, which means coverage varies dramatically depending on where you live. This creates a patchwork of coverage that can be confusing—but understanding your state's rules is essential.
The Federal Requirement: Children MUST Be Covered
All 50 states MUST provide hearing aid coverage for children under age 21 through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) mandate. This is non-negotiable and applies nationwide.
Pediatric coverage typically includes:
- Hearing aids (replacement as child grows or devices malfunction)
- Hearing tests and evaluations
- Fittings and adjustments
- Earmolds
- Batteries and supplies
If your child has Medicaid or CHIP (Children's Health Insurance Program), they have hearing aid coverage regardless of your state.
Adult Coverage: Where Geography Determines Access
25 states plus Washington D.C. provide hearing aid coverage for adults (age 21+) with no age or facility restrictions. This means if you qualify for Medicaid in one of these states, you have potential access to hearing aids.
8 states provide NO adult Medicaid coverage for hearing aids:
- Alabama
- Florida
- Idaho
- Mississippi
- Missouri
- South Carolina
- Wyoming
- Kansas (nursing home residents only)
If you live in one of these states and have Medicaid, you'll need to explore financial assistance programs, lower-cost device options, or out-of-pocket payment.
States with Restricted Coverage
Remaining states offer coverage with limitations:
- Age restrictions: Some states cover adults only above certain ages (e.g., 65+)
- Facility restrictions: Coverage only for nursing home residents or those in long-term care
- Waiting lists: States experiencing budget constraints may have waitlists for hearing aid coverage
- Limited device types: Some states cover only basic analog devices or restrict to certain manufacturers
Medicaid Coverage Amounts (When Available)
States that provide adult coverage typically offer:
| State (Examples) | Coverage Amount | Frequency |
|---|---|---|
| Oregon | Up to $4,000 per aid | Every 48 months |
| Minnesota | $3,000 per ear | Every 3 years |
| South Dakota | $1,500 per ear | Every 3 years |
| California | Varies by managed care plan | As medically necessary |
| New York | Full coverage for approved devices | Every 5 years or as needed |
Prior Authorization Requirements
Most state Medicaid programs require prior authorization before covering hearing aids. This means:
- Your audiologist must submit documentation of medical necessity
- Recent hearing test results (typically within 6 months) required
- May need letter from primary care physician supporting need
- Authorization process takes 2-4 weeks on average
- Approval not guaranteed—denials can be appealed through state Fair Hearing process
How to Apply for Medicaid Hearing Aid Coverage
Step 1: Determine eligibility. Medicaid eligibility is based on income, household size, and in some cases, disability status. In states that expanded Medicaid under the ACA, adults qualify if income is at or below 138% of the Federal Poverty Level (includes 5% income disregard).
2025 Federal Poverty Level examples:
- Individual: $15,060/year (138% = $20,783)
- Family of 2: $20,440/year (138% = $28,207)
- Family of 4: $31,200/year (138% = $43,056)
Step 2: Apply for Medicaid. Apply through your state Medicaid office, online at your state's health insurance marketplace, or by calling your state Medicaid hotline. Find contact information at Medicaid.gov.
Step 3: Get a hearing evaluation. Once enrolled, see an audiologist who accepts Medicaid. Get a comprehensive hearing test within the past 6 months (many states require recent testing).
Step 4: Submit prior authorization (if required). Your audiologist will typically handle this, submitting:
- Hearing test results (audiogram)
- Medical necessity documentation
- Specific hearing aid recommendation with pricing
- Any required physician referrals
Step 5: Wait for authorization decision. Typical timeline: 14-30 days. If approved, proceed with hearing aid fitting. If denied, you can appeal through your state's Medicaid Fair Hearing process (30-90 days depending on state).
Dual Eligibility: Medicare + Medicaid Together
12 million Americans qualify for both Medicare and Medicaid simultaneously. This "dual eligibility" can provide the most comprehensive hearing care coverage available through public insurance.
Who Qualifies for Dual Eligibility
You may qualify if you:
- Are age 65+ and have low income/assets, OR
- Have a disability and receive Social Security Disability Insurance (SSDI), AND
- Meet your state's Medicaid income and resource limits
How Dual Eligibility Works for Hearing Care
Medicare Savings Programs (MSPs): Help pay Medicare premiums, deductibles, and coinsurance. Income limits: 100-135% of Federal Poverty Level depending on program (QMB, SLMB, QI).
Full Medicaid: If you have full Medicaid benefits AND live in a state that covers adult hearing aids, Medicaid can fill gaps that Medicare doesn't cover. This means:
- Medicare covers diagnostic hearing tests, cochlear implants, and medical treatment
- Medicaid (in applicable states) covers hearing aids, fittings, and supplies
- Together: Comprehensive hearing care at low or no cost
D-SNPs (Dual-Eligible Special Needs Plans): These Medicare Advantage plans are specifically designed for people with both Medicare and Medicaid. They coordinate benefits between both programs and often provide enhanced hearing benefits. 7.3 million people are enrolled in SNPs (21% of Medicare Advantage enrollment).
How to Access Dual Eligible Benefits
1. Apply for Medicare through the Social Security Administration (automatically enrolled at age 65 if receiving Social Security, or apply online at ssa.gov).
2. Apply for Medicaid through your state Medicaid office.
3. Consider D-SNPs during Medicare Advantage open enrollment if you want coordinated coverage through one plan.
4. Work with your state's SHIP (State Health Insurance Assistance Program) for free counseling on coordinating benefits. Find your local SHIP at shiphelp.org.
Frequently Asked Questions
The Bottom Line
Medicare and Medicaid coverage for hearing aids is a patchwork—but understanding the landscape helps you find the coverage available to you.
If you have Original Medicare: You have no hearing aid coverage, but you have options. Medicare Advantage plans offer hearing benefits to 97% of enrollees—consider switching during open enrollment. Cochlear implants ARE covered when medically necessary.
If you have Medicare Advantage: Check your specific plan's hearing benefits. Coverage ranges from $500-$2,500 per ear, with varying frequency limits and network restrictions. Use the Medicare Plan Finder to compare plans annually—benefits change.
If you have Medicaid: Children under 21 have coverage in all states. Adults have coverage in 25 states plus D.C. with no restrictions, no coverage in 8 states, and limited coverage in remaining states. Contact your state Medicaid office to verify.
If you're dual eligible (Medicare + Medicaid): You may have the most comprehensive public insurance hearing coverage available. Explore D-SNPs that coordinate both programs' benefits.
What all programs have in common: Prior authorization typically required, network restrictions common, and appeal processes exist when coverage is denied. Understanding these rules—and planning around open enrollment periods—maximizes your access to public insurance benefits for hearing healthcare.
Next Steps in Your Coverage Journey
Understanding Medicare and Medicaid is just the beginning. Here's where to go next: