Medicare Hearing Aid Coverage: What Original Medicare Pays For (and What It Doesn't)

Original Medicare doesn't pay for hearing aids. It also doesn't pay for the exam to fit them. That's federal law, not a billing quirk: Section 1862(a)(7) of the Social Security Act bars payment for "hearing aids or examinations therefor," and CMS repeats it in 42 CFR 411.15(d).

That doesn't mean Medicare ignores your ears. Part B pays for diagnostic hearing tests, and since 2023 you can see an audiologist once a year without a doctor's order for certain conditions. Cochlear implants and bone-anchored implants are covered as prosthetic devices. The line between "covered" and "you pay all of it" is specific, and it's worth knowing before you book an appointment. Here's where it falls, and what people in Washington can use to fill the gap.

Source: NIDCD (NIH), Quick Statistics About Hearing (disabling hearing loss means 35 decibels or more in the better ear, based on 2015-2020 national exam data); Medicare.gov, Hearing aids.

Those numbers explain why this question comes up so often. More than half of people 75 and older have hearing loss at the level where hearing aids generally help, according to the National Institute on Deafness and Other Communication Disorders. Original Medicare won't buy the device for any of them.

The rule: what the exclusion covers

The regulation is narrower and more technical than "no hearing aids." Under 42 CFR 411.15(d), Medicare excludes "hearing aids or examinations for the purpose of prescribing, fitting, or changing hearing aids." The scope covers two kinds of devices:

• Air conduction hearing aids, the familiar behind-the-ear and in-the-ear devices that amplify sound into the ear canal.
• Bone conduction hearing aids that vibrate through the scalp or press against the eardrum or the small bones of the middle ear.

Then the rule carves out devices that don't just amplify sound but replace the work of a damaged part of the ear: osseointegrated implants anchored in the skull bone, cochlear implants, and auditory brainstem implants. Those aren't hearing aids in Medicare's eyes. CMS's Benefit Policy Manual, chapter 16 treats them as prosthetic devices, which Medicare covers (Part A or Part B, depending on the surgery setting).

The manual is blunt about everything else: "Medicare contractors deny payment for an item or service that is associated with any hearing aid." Batteries, fittings, adjustments: if it's tied to a hearing aid, Original Medicare won't pay for it.

Source: 42 CFR 411.15(d); CMS Medicare Benefit Policy Manual, ch. 16, §100; Medicare.gov, Hearing & balance exams; Medicare.gov, Prosthetic devices.

What Part B does pay for: diagnostic hearing exams

Part B covers diagnostic hearing and balance exams "if your doctor or other health care provider orders them to find out if you need medical treatment," per Medicare.gov. That includes balance (fall risk) testing, and it's the route when your doctor wants a hearing problem evaluated as a medical issue.

The 2023 change: direct access to an audiologist. CMS's CY 2023 Physician Fee Schedule final rule let people on Medicare see an audiologist without a physician's order, starting with dates of service on January 1, 2023. Medicare.gov describes the current rule: you can visit an audiologist once every 12 months without an order, but only for:

• non-acute hearing conditions, like hearing loss that develops over many years, and
• diagnostic services related to hearing loss treated with surgically implanted hearing devices.

The direct-access visit still can't be about hearing aids. CMS's fact sheet says it covers assessments "unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids." So you can walk in and get your gradual hearing loss evaluated, but the moment the visit turns into a hearing aid evaluation or fitting, that part is on you.

What you pay. Covered hearing exams get standard Part B cost sharing: 20% of the Medicare-approved amount after the Part B deductible, plus a copayment to the hospital if the test is done in a hospital outpatient department.

Source: CMS, 2026 Medicare Parts A and B premiums and deductibles; Medicare.gov, Hearing & balance exams; Medicare.gov, Prosthetic devices. CMS announces the next year's amounts each fall; 2027 figures had not been released when this was written.

Example (hypothetical): Say your doctor orders a diagnostic hearing evaluation in an audiologist's office and the Medicare-approved amount is $150. If it's your first Part B service of 2026, the whole $150 goes toward your $283 deductible and you pay it. If you've already met the deductible, you pay 20%, or $30. Either way, if the audiologist then spends time picking and programming a hearing aid, that part isn't covered at all.

Cochlear implants and bone-anchored devices

Medicare lists cochlear implants among the "surgically implanted prosthetic devices" it covers on its prosthetic devices page. Part A covers the device if the surgery happens during an inpatient stay; Part B covers it if the surgery is outpatient. Medicare only pays for a prosthetic from a supplier that participates in Medicare.

Coverage isn't automatic. CMS's national coverage determination, NCD 50.3 (Cochlear Implantation), effective September 26, 2022, covers implants for bilateral, moderate-to-profound sensorineural hearing loss in people who get limited benefit from hearing aids. "Limited benefit" means scoring 60% or less on recorded open-set sentence recognition tests in the best-aided listening condition (with the hearing aids that work best for you). You also have to meet all of these:

• a diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids
• the cognitive ability to use auditory cues and a willingness to go through an extended rehabilitation program
• no middle ear infection, a cochlea structurally suited to the implant, and no lesions in the auditory nerve or the hearing areas of the brain
• no reasons you can't have surgery
• a device used according to its FDA-approved labeling

Osseointegrated implants, the bone-anchored devices surgically fixed in the skull, sit outside the hearing aid exclusion too. CMS's manual says these implantable devices are meant for people for whom hearing aids are "medically inappropriate or cannot be utilized due to congenital malformations, chronic disease, severe sensorineural hearing loss or surgery." Your ear, nose and throat surgeon's office should check Medicare's criteria and document them before surgery is scheduled.

Once you have an implant, Medicare.gov's direct-access rule covers diagnostic services related to it, and CMS's manual points to its rules on medically necessary treatment of complications, such as removing an implanted device because of infection (§180), so those can be covered.

Medigap won't pay for hearing aids either

A Medicare Supplement (Medigap) policy pays your share of costs for services Original Medicare covers. Beyond a few extras like foreign travel emergency care, it doesn't add new benefits. Medicare.gov's Medigap page lists what Medigap plans "generally don't cover," and hearing aids are on it, alongside vision or dental care, glasses, long-term care and private-duty nursing. The Medicare & You 2027 handbook says the same thing on page 79.

Where Medigap does help: the 20% on a covered diagnostic exam, or your share of a covered cochlear implant, depending on the plan letter. If you're weighing Medigap in Washington, the Medicare Supplement page explains the plan letters.

Medicare Advantage and hearing benefits

Medicare Advantage (Part C) plans must cover all medically necessary services that Original Medicare covers, so diagnostic exams and qualifying implants are included. Medicare.gov says these plans "may also offer extra benefits that Original Medicare doesn't cover," naming some vision, hearing and dental services. Its hearing aids page puts it plainly: some plans offer hearing extras, so "contact the plan for more information."

The word that matters is "may." Hearing extras are optional, so they differ from plan to plan and can change every January. The details that decide whether a benefit is useful to you are in the plan's Evidence of Coverage, the document that spells out what the plan covers and what you pay for the coming year. When you read it, look for:

• whether hearing aids are included at all, or only a routine hearing test
• any yearly or multi-year dollar limit, and how often you can get new devices
• whether you must use a specific network of hearing providers or suppliers
• what you pay out of pocket per device and whether fittings and follow-up visits are included
• whether prior authorization is required

You can compare plans' extra benefits in the Medicare.gov plan finder or by calling 1-800-MEDICARE. Don't pick a health plan for hearing aids alone, though. Your doctors, hospitals and prescriptions matter more over a year. Our comparison of Medicare Advantage vs. Medigap in Washington walks through those trade-offs. Open Enrollment runs October 15 to December 7.

Over-the-counter hearing aids

A big change in hearing aid access didn't come from Medicare. It came from the FDA. A new category of over-the-counter (OTC) hearing aids took effect on October 17, 2022, for adults 18 and older with perceived mild to moderate hearing loss, according to the FDA. You can buy them in a store or online without seeing an ear, nose and throat doctor or an audiologist.

The limits matter. The FDA says OTC devices are "NOT for the treatment of severe or profound hearing loss," because their maximum output is capped. The FDA also requires a "When to See a Doctor" warning on the box. It lists, among other things, hearing that changed suddenly in the past six months, worse hearing in one ear, ringing or buzzing in only one ear, and dizziness or vertigo. Any of those is a reason to get a diagnostic exam first, which Part B can cover with a doctor's order.

Medicare doesn't pay for OTC hearing aids any more than prescription ones; the exclusion covers all hearing aids. Neither does Apple Health for adults (more on that below). The FDA takes reports of problems with OTC devices through MedWatch or at 1-800-FDA-1088.

Apple Health hearing aids for people with Medicare in Washington

For people in Washington with Medicare and limited income, Apple Health (Washington Medicaid) is the program that actually buys hearing aids. Under the benefit table in WAC 182-501-0060, hearing evaluations and hearing aids are part of the Categorically Needy and Medically Needy packages, the Classic Medicaid coverage people on Medicare can qualify for. HCA says any Apple Health coverage you have alongside Medicare "will work as a secondary insurance to Medicare": Medicare pays first, and Apple Health may help with expenses Medicare doesn't cover.

The rules for adults are in chapter 182-547 WAC. Before Apple Health pays, you need a hearing evaluation with an audiogram given and interpreted by a hearing health care professional, and a licensed audiologist, hearing aid specialist or ear physician has to conclude you could benefit from a hearing aid.

Source: WAC 182-547-0100, -0850 and -0900; WAC 182-501-0060. If you get Apple Health through a managed care plan, WAC 182-547-0700 says you arrange hearing aids through that plan.

One catch. The Medicare Savings Programs are part of Apple Health too, but on their own they pay Medicare costs, not extra benefits. HCA's MSP page lists what each pays: QMB covers Part A and B premiums, deductibles and copayments; SLMB and QI-1 pay the Part B premium. An approval letter for an MSP alone doesn't mean you have Apple Health hearing aid coverage. Our Apple Health and Medicare guide lays out the income and resource limits for full Classic Medicaid, and HCA answers Apple Health questions at 1-800-562-3022.

Is any of this changing for 2027?

Not that I can see in the rules released so far. CMS's CY 2027 Physician Fee Schedule final rule fact sheet, released November 4, 2026, doesn't mention audiology or hearing services, so the direct-access rule stays as it is. CMS hasn't announced 2027 Part A and Part B amounts yet; it does that each fall.

Congress could change the exclusion, because it's in the statute. Bills to do that have been introduced. For example, H.R. 6218, the HEAR Act of 2025, introduced November 20, 2025, would add hearing aids and related services to Medicare. An introduced bill isn't law. As of today, the regulation and Medicare.gov both still say Original Medicare doesn't cover hearing aids. Plan around the current rule, not a bill.

What to do if you need hearing aids on Medicare

1. Get the diagnosis covered first. If your hearing changed or you've never been tested, ask your doctor to order a diagnostic hearing exam, or use the once-a-year direct audiologist visit for gradual hearing loss. That part is a Part B service.
2. Split the visit in your head. Diagnostic testing is billed to Medicare; the hearing aid evaluation and fitting are not. Ask which is which, and get prices in writing.
3. Check Apple Health. If your income and resources are limited, find out whether you qualify for full Classic Medicaid. It's the one program here with written hearing aid coverage rules for adults.
4. If you're in a Medicare Advantage plan, read the hearing section of your Evidence of Coverage, and call the plan to confirm the network and any dollar limits before you buy anything.
5. Consider OTC devices only for mild to moderate loss. Severe loss, a sudden change or hearing loss in one ear calls for a medical exam first, per the FDA's own warning label.
6. If an implant is on the table, ask the surgeon's office to confirm in writing that you meet Medicare's criteria and that the supplier participates in Medicare.
7. Get unbiased help. SHIBA counselors can walk through your options with you. Our guide to SHIBA in Washington explains how to reach a local counselor.

Source: Washington OIC, SHIBA; HCA, Age 65 and older or Medicare eligible; Medicare & You 2027; FDA, OTC Hearing Aids.

For broader Medicare questions, see our Washington Medicare page or the Washington insurance FAQ. Dental has a similar exclusion with a few medical exceptions; our Medicare dental coverage guide covers that one.

FAQ

Does Medicare cover hearing aids?

Original Medicare doesn't cover hearing aids or exams for fitting them. Federal law excludes them, so you pay all costs. Some Medicare Advantage plans offer hearing extras, and Apple Health covers hearing aids for adults who qualify in Washington.

Does Medicare cover hearing tests?

Part B covers diagnostic hearing and balance exams when your doctor orders them to find out if you need medical treatment. You can also see an audiologist once every 12 months without an order for non-acute hearing conditions. You pay 20% of the Medicare-approved amount after the Part B deductible.

Does Medicare cover cochlear implants?

Yes, as prosthetic devices, if you meet Medicare's coverage criteria in NCD 50.3. Part A covers the device for inpatient surgery and Part B for outpatient surgery.

Does Medigap cover hearing aids?

Generally no. Medigap pays your share of costs for services Original Medicare covers, and Medicare.gov lists hearing aids among the things Medigap plans generally don't cover.

Federal Medicare rules, your own plan or policy documents and Washington law control what's covered. Confirm your situation with Medicare, SHIBA, HCA or a licensed agent before you buy hearing aids or schedule a fitting.

Sources

1. Medicare.gov: Hearing aids
2. Medicare.gov: Hearing & balance exams
3. Medicare.gov: Prosthetic devices
4. Medicare.gov: What Medigap covers
5. Medicare.gov: Compare Original Medicare and Medicare Advantage
6. Medicare & You 2027 (pages 45, 58, 67, 79)
7. Medicare.gov plan finder
8. eCFR: 42 CFR 411.15, particular services excluded from coverage
9. CMS Medicare Benefit Policy Manual, chapter 16 (§100 Hearing aids and auditory implants)
10. CMS: NCD 50.3 Cochlear Implantation
11. CMS: CY 2023 Physician Fee Schedule final rule fact sheet
12. CMS: CY 2027 Physician Fee Schedule final rule fact sheet (Nov. 4, 2026)
13. CMS: 2026 Medicare Parts A and B premiums and deductibles
14. CMS MLN006266: Medicare Advance Written Notices of Non-coverage
15. FDA: OTC Hearing Aids: What You Should Know
16. NIDCD (NIH): Quick Statistics About Hearing, Balance, & Dizziness
17. H.R. 6218 (119th Congress), HEAR Act of 2025, introduced text
18. WAC chapter 182-547: Hearing aids
19. WAC 182-501-0060: Program benefit packages
20. HCA: Age 65 and older or Medicare eligible
21. HCA: Medicare Savings Program
22. Washington OIC: Get free Medicare help from SHIBA