Does Medicare cover cochlear implants?
Checking in on your hearing health becomes more and more critical as you grow older, especially since hearing loss has been linked to dementia. If you have more severe issues, you might need a cochlear implant. These devices require surgery and help you hear better by stimulating the auditory nerve.
If you meet certain eligibility criteria, Medicare will cover some or all of the cost of a cochlear implant and other hearing implants.
Key takeaways:
A cochlear implant is a surgically implanted device in your ear to help with severe to profound hearing loss.
Original Medicare and Medicare Advantage can help pay for a cochlear implant, which includes the surgical procedure, device, and rehabilitation. There may still be some out-of-pocket costs.
What is a cochlear implant?
A cochlear implant is a surgically implanted device designed to help people with severe to profound hearing loss. This device is different from hearing aids in that it directly stimulates the auditory nerve with electrical pulses to send signals to the brain. In this way, sound bypasses the damaged parts of the ear and your brain receives the sound signals directly, so you can hear better.
Cochlear implants are made up of an external part that is connected to a microphone and a speech processor to be worn behind your ear. It also includes an internal part that a medical professional surgically places inside your ear. Once installed, it takes most people about 6-12 months to get used to wearing a cochlear implant.
How do cochlear implants compare to hearing aids?
Hearing aids are not surgically implanted, and they help with hearing by amplifying the sound around you. People who need cochlear implants generally have fair to poor hearing capabilities, comprehending about 50% of words or less during a test, while those that need hearing aids generally have better speech understanding capabilities.
Cost of a cochlear implant
Without insurance, a cochlear implant can cost between $30,000 to $50,000. Thankfully, most major insurance companies and federal insurance programs, including Medicare, provide coverage for implantation if you are eligible to get a cochlear implant.
Does Medicare cover the cost of a cochlear implant?
Yes, Medicare can pay for cochlear implants. The total costs include the device, surgical implantation, and rehabilitation. Depending on your coverage, you may still have to pay some out-of-pocket costs. Keep in mind that you’ll need to visit a Medicare-enrolled facility in order to get Medicare coverage for cochlear implants.
Original Medicare (Part A and Part B) and Medicare Supplement
If you have Original Medicare, Part B covers cochlear implants because they are considered prosthetic devices. This is an important distinction because hearing aids, which are not considered prosthetic devices, are not covered by Original Medicare.
Part B will pay for 80% of the cost of cochlear implants if you’re eligible for them after reaching your deductible. In 2024, the Part B deductible is $240. Without a Medicare Supplement plan, you’ll need to pay the full 20% not covered by Medicare, which averages to $1,800 for cochlear implants.
Medicare Advantage (Part C)
By law, Medicare Advantage is required to cover the same services as Original Medicare. If you’re on a Medicare Advantage plan, you also have coverage for cochlear implants. However, MA policies each have different cost structures (deductibles and coinsurance). This means your out-of-pocket costs can vary from one plan to another.
One other thing to note is that many Medicare Advantage plans require prior authorizations for covered services. You’ll need prior authorizations before getting a cochlear implant.
Check with your insurance provider and your doctor's billing department to get a sense of what you can expect to pay and your eligibility for a cochlear implant.
Medicare eligibility requirements for cochlear implant coverage
As of 2022, Medicare made changes to cover even more of the costs of cochlear implants and to expand coverage to more people. Medicare recipients who can’t hear 40% of any conversation based on a spoken sentence-comprehension test can get cochlear implants covered by Medicare. Previously, you needed more severe hearing impairment to receive Medicare coverage for cochlear implants.
Medicare enrollees need to meet the following requirements to be eligible for cochlear implant coverage:
Your doctor diagnoses you with a moderate-to-profound inner ear hearing impairment.
Hearing aids don’t help your impairment much.
You are able to use auditory clues and want to go through a program to restore any form of hearing loss.
You do not have a middle ear infection.
Your ear can undergo the implant and procedure.
Your ear does not have lesions in the auditory nerve and areas around the central nervous system.
The surgery will not be harmful to you.
The cochlear device is FDA-approved and used accordingly.
Cochlear implants are an important option for anyone with a hearing impairment. They can be expensive, especially because they need to be surgically implanted. Fortunately, Medicare can cover most, if not all, of the costs of the device, implantation, and recovery.
If you have questions about Medicare insurance coverage, including hearing benefits, we’re here to help! Call us today at (855)-900-2427 for free Medicare advice and support.