Jeffrey Wade
Hearing tests are typically covered by insurance if you have a referral from a healthcare provider. Medicare Part B covers diagnostic hearing and balance exams if your doctor or healthcare provider orders them to determine if you require medical treatment. However, the extent of coverage depends on the specific details of your insurance policy. For example, Medicaid programs in certain states only cover hearing aids for individuals under a certain age. Commercial health insurance carriers like United Healthcare and Cigna will typically cover an annual hearing test without a referral, and Medicare Advantage plans may offer benefits that include the cost of hearing tests and hearing aids.
| Characteristics | Values |
|---|---|
| Medicare Part B covers hearing tests | If a doctor or healthcare provider orders them to check for a hearing or balance problem |
| Medicare covers hearing tests | If a physician refers a beneficiary to an audiologist for testing related to signs or symptoms associated with hearing loss, balance disorder, tinnitus, ear disease, or ear injury |
| Medicare covers hearing tests | If a non-physician practitioner (nurse practitioner, clinical nurse specialist, or physician’s assistant) orders the evaluation to inform the physician's diagnostic medical evaluation |
| Commercial health insurance carriers like United Healthcare, Cigna, Anthem, etc. cover hearing tests | Annual hearing tests and/or tinnitus evaluation without a Primary Care Physician (PCP) referral |
| Medicaid programs in Colorado and Arizona cover hearing aids | For individuals under the age of 20 and 21, respectively |
| Medicare Advantage plans cover hearing tests and hearing aids | Vary by plan |
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What You'll Learn
Medicare Part B covers diagnostic hearing tests
You can visit an audiologist once every 12 months without a doctor's referral, but only for non-acute hearing conditions like hearing loss that occurs over many years. Medicare Part B covers eligible hearing tests once you've paid your annual deductible. After that, you'll pay 20% of the Medicare-approved amount for your doctor visit and tests.
Medicare Part B may not cover the cost of hearing aids, but Medicare Advantage plans may. These plans vary, so check the details of your plan or contact your provider for more information.
If you have served in the military, naval, or air services, you may qualify for a hearing aid through the VA healthcare system. Some states also offer financial assistance programs for hearing aids based on income or other requirements.
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Referral from a healthcare provider may be required
Whether your insurance covers hearing tests depends on your provider and your specific policy. Medicare Part B, for example, covers diagnostic hearing and balance exams if your doctor or healthcare provider orders them to determine if you require medical treatment. You can also visit an audiologist once every 12 months without a doctor's order, but only for non-acute hearing conditions and diagnostic services related to hearing loss that is treated with surgically implanted hearing devices. After meeting the Part B deductible, you will pay 20% of the Medicare-approved amount.
Original Medicare does not cover the cost of hearing aids, but most Medicare Advantage plans will pay for them, with the amount varying by plan. Some plans also cover the cost of hearing tests, fittings, repairs, and education on the proper usage of hearing aids. Certain Medicare Advantage plans offer benefits that include hearing screenings with no or low copayment.
Medicaid programs in different states also have varying policies. For instance, the programs in Colorado and Arizona only cover hearing aids for individuals under the ages of 20 and 21, respectively.
Commercial health insurance carriers like United Healthcare, Cigna, and Anthem typically cover an annual hearing test and/or tinnitus evaluation without a Primary Care Physician (PCP) referral. However, it is always best to check with your insurance provider before scheduling a hearing test to determine if a referral from a healthcare provider is required and what specific costs will be covered.
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Commercial health insurance carriers often cover annual hearing tests
Hearing tests are often covered by insurance, but the extent of coverage depends on the specific policy. Commercial health insurance carriers like United Healthcare, Cigna, and Anthem typically cover an annual hearing test without a referral from a Primary Care Physician (PCP). They may also provide benefits for treatment. Medicare Part B also covers diagnostic hearing and balance exams if ordered by a doctor or healthcare provider to determine medical treatment. Medicare Advantage plans may also offer benefits that include hearing tests, hearing aids, and cochlear implants if deemed medically necessary.
Medicare generally does not recognise audiologists as treatment providers, and their services must be billed directly to Medicare. However, Medicare may cover the labour for the technical component of diagnostic tests performed by audiologists under physician supervision. A physician's order is required for Medicare to cover audiologist services, even if the outcome is only the prescription of a hearing aid.
Medicaid programs in certain states also cover hearing aids, but age restrictions apply. For example, Medicaid in Colorado covers hearing aids for individuals under 20, while Arizona covers those under 21. It is important to review your insurance policy to understand the specific coverage provided for hearing tests and related services.
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Medicare Advantage plans may cover hearing tests and hearing aids
Medicare Advantage plans, also known as Part C, are bundled plans that offer coverage for things not included in Parts A and B. While Original Medicare does not cover the cost of hearing aids or routine hearing exams for adults, most Medicare Advantage plans will pay for hearing aids and hearing tests. The amount of coverage, however, varies by plan. Some plans cover one routine hearing exam per year, while others cover hearing aids and one hearing aid fitting per year.
Medicare Part B (Medical Insurance) covers diagnostic hearing and balance exams if your doctor or healthcare provider orders them to determine a medical treatment. You can also visit an audiologist once every 12 months without a doctor's referral, but only for non-acute hearing conditions (like hearing loss that happens over many years) and diagnostic services related to hearing loss treated with surgically implanted hearing devices. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.
It is important to note that Medicare Advantage plans can vary, so it is recommended to check the Evidence of Coverage (EOC) for details on each plan's benefits.
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Audiologists must bill Medicare directly for diagnostic testing
Medicare Part B covers diagnostic hearing and balance exams if your doctor or healthcare provider orders them to determine medical treatment. Medicare also covers hearing tests without a doctor's order once every 12 months for non-acute hearing conditions and diagnostic services related to surgically treated hearing loss. Most insurance providers will also cover hearing tests with a referral from your healthcare provider.
Audiologists who provide diagnostic testing for the hearing and vestibular systems to Medicare beneficiaries must bill Medicare directly for their services. These services cannot be billed "incident to" a physician because they are a defined benefit for audiologists. The National Provider Identifier (NPI) of the audiologist must be listed on the claim as the rendering provider of the services. Audiologists do not have an "opt-out" provision in their definition that allows private contracts with Medicare beneficiaries. If the service is covered by Medicare, there is a mandatory claim submission as defined by law (Social Security Act, Section 1848). Violations of the mandatory submission rule may result in a civil penalty of up to $2,000 for each violation.
Audiologists providing treatment services or other diagnostic services outside of the hearing and balance definition cannot directly bill Medicare for those services. Medicare does not recognize audiologists as treatment providers, but the labor for the technical component (TC) of other diagnostic tests or treatment services may qualify to be billed when furnished by audiologists under physician supervision. Audiologists should ensure they are performing services within the scope of practice according to state law and possess the qualifications ordinarily required of any person providing that service.
For Medicare beneficiaries in a noncovered SNF stay, audiology services are payable under Part B when billed directly by the audiologist on a professional claim. For beneficiaries in a covered SNF stay, audiology services are payable under Part A, and the SNF bills for the services provided by the audiologist.
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Frequently asked questions
It depends on your insurance provider and your policy. Medicare, for instance, covers hearing tests if they are deemed medically necessary and are ordered by a doctor or healthcare provider.
No, Medicare Advantage plans offer benefits that include the cost of hearing tests and aids, but coverage varies by plan.
Medicaid programs in different states have different age restrictions for covering hearing aid costs. For instance, in Colorado and Arizona, Medicaid only covers hearing aids for individuals under the age of 20 and 21, respectively.
Yes, most insurance providers will cover hearing tests if you have a referral from your healthcare provider. However, some commercial health insurance carriers like United Healthcare, Cigna, and Anthem do not require a referral.
A standard hearing test can cost anywhere between $60 and $165.
