Does Medicare Cover Hearing Exams?

What Original Medicare covers

Part B covers diagnostic hearing and balance exams when your doctor or another treating provider orders them to find out whether you need medical treatment — sudden or unexplained hearing loss, dizziness or balance problems, ringing in the ears, or hearing changes after an illness, an injury, or a medication known to affect hearing. Medicare also allows a visit to an audiologist once every 12 months without a doctor's order for certain non-acute hearing concerns; ask the audiologist's office whether your visit qualifies before you go.

What it does NOT cover

Routine hearing checkups — the "let's see how your hearing is doing" visit with no medical question behind it — and any exam whose purpose is fitting or prescribing hearing aids. The hearing aids themselves are not covered either.

The conditions and limits

Coverage follows the reason for the exam, and that reason is set before the visit, not after. The same audiologist, the same booth, and the same test can be covered or not covered depending on whether it was ordered to evaluate a medical problem or booked on the way to a hearing aid. If the answer matters to your wallet, ask how the visit will be billed when you schedule it.

What it costs you

For a covered diagnostic exam, you generally pay 20% of the Medicare-approved amount after the $283 Part B deductible, plus a copay if it happens in a hospital outpatient department. A routine or hearing-aid exam is billed to you in full.

Many Medicare Advantage plans add routine hearing exams as an extra benefit, with plan-specific rules in the Evidence of Coverage.

Doctor or advisor?

New or sudden hearing loss, dizziness, or ear pain is a medical matter — call your doctor, and do not wait on it; sudden hearing loss in particular is treated as urgent. Questions about what a routine exam will cost you, or whether your coverage includes one, go to your plan — or to a licensed agent or State Health Insurance Assistance Program (SHIP) counselor if you are taking a wider look at your options.