Medicare's coverage of hearing exams and earwax removal
Medicare Part B covers a cerumen removal (earwax removal) performed by a doctor when earwax is blocking your ear canal and affecting your hearing. A doctor must perform the procedure — it cannot be done by an audiologist or nurse. Medicare will pay 80% of the approved amount after you meet your Part B deductible, and you pay the remaining 20%.
Medicare does not cover routine hearing exams or hearing tests done for the purpose of fitting hearing aids. If your doctor orders a hearing test to diagnose a medical condition — such as sudden hearing loss, dizziness, or balance problems — that test may be covered as part of your diagnostic workup. The key difference is the reason for the test, not the test itself.
If you need a hearing aid, you will pay for the hearing exam out of pocket. Original Medicare does not cover hearing aids or the exams required to fit them. Some Medicare Advantage plans (Part C) do offer hearing aid coverage, but the amount and rules vary widely by plan.
Key Takeaways
- Medicare Part B covers earwax removal only when a doctor performs it and earwax is blocking your ear canal.
- Hearing exams for fitting hearing aids are not covered by Original Medicare, and you will pay the full cost.
- A hearing test ordered by your doctor to diagnose a medical condition may be covered as part of that diagnosis.
- Some Medicare Advantage plans include hearing aid coverage, but benefits differ by plan and by year.
- You pay 20% of the approved amount for covered earwax removal after meeting your Part B deductible.
When Medicare covers a hearing test
Your doctor may order a hearing test if you report sudden hearing loss, ringing in your ears (tinnitus), dizziness, or balance problems. In these cases, the test is diagnostic — it helps your doctor figure out what is causing your symptoms. Medicare will cover the test as part of your visit and workup for that condition.
The test itself looks the same whether it is diagnostic or for a hearing aid fitting, but Medicare's payment depends on why your doctor ordered it. If your doctor documents that the test is medically necessary to diagnose or treat a condition, Medicare will likely cover it. If the test is ordered solely to measure your hearing for the purpose of fitting a hearing aid, it is not covered.
Ask your doctor whether the hearing test is being ordered for a medical reason or for hearing aid fitting. If it is diagnostic, your doctor's office should code it that way when they submit the claim to Medicare.
Earwax removal and what to expect
Earwax buildup is common and can muffle sound or cause discomfort. If earwax is blocking your ear canal, your primary care doctor or an ear, nose, and throat (ENT) specialist can remove it in the office. The procedure takes a few minutes and usually involves flushing the ear with water or using a small instrument to gently remove the wax.
Medicare covers this procedure when a physician performs it. You do not need a referral, but you do need to see a doctor — not a nurse practitioner or physician assistant alone, though they may information. After you meet your Part B deductible for the year, Medicare pays 80% of the approved amount, and you pay 20%.
If earwax removal is done in a hospital outpatient department rather than a doctor's office, different rules may explore and your costs could be higher. Ask your doctor's office whether the procedure will be done in the office or at a hospital facility.
Hearing aids and what Medicare does not cover
Original Medicare (Part A and Part B) does not cover hearing aids, hearing aid fittings, or the hearing exams needed to fit them. This is a long-standing exclusion. If you need a hearing aid, you will pay the full cost out of pocket, which typically ranges from a few hundred dollars to several thousand dollars per aid depending on the type and features.
Some Medicare Advantage plans (Part C) do cover hearing aids, but coverage varies significantly. Some plans cover one or both ears; some cover a percentage of the cost; some cover the full cost. A few plans cover hearing aids every year, while others cover them every two or three years. You must check your specific plan's coverage documents or call the plan directly to learn what is included.
If you are considering a Medicare Advantage plan during open enrollment, ask about hearing aid coverage before you enroll. If you already have a plan, review your Summary of Benefits and Coverage or call your plan's customer service line to confirm what hearing services are covered.
How to find out what your plan covers
If you have Original Medicare, you can assume hearing aids and hearing exams for fitting are not covered. If you have a Medicare Advantage plan, you need to check your plan documents.
Look for your plan's Summary of Benefits and Coverage document, which lists what is and is not covered. This document is mailed to you each year and is also available on your plan's website. Search for "hearing" or "audiology" in the document.
If the document is unclear or you cannot find it, call your plan's customer service number (on your insurance card) and ask directly: "Does my plan cover hearing aids? Does it cover hearing exams for fitting hearing aids? If so, how much does it cover, and how often?" Write down the answers and the date and time you called.
What to ask your doctor
Before your appointment, write down these questions:
- Is the hearing test you are ordering medically necessary to diagnose a condition, or is it for hearing aid fitting?
- Will the earwax removal be done in your office or at a hospital facility?
- Do you know whether Medicare will cover this test or procedure?
- What will my out-of-pocket cost be after insurance?
If your doctor orders a hearing test, ask the office staff to submit the claim to Medicare and let you know what you owe. Do not assume you will receive a bill — sometimes the office will write off the patient's share if the claim is denied.
When to seek care for hearing problems
See your doctor right away if you experience sudden hearing loss in one or both ears, especially if it happened over hours or days. Sudden hearing loss can be a sign of a medical emergency and may be treatable if caught early.
See your doctor if earwax buildup is causing pain, hearing loss, or a feeling of fullness in your ear. Do not try to remove earwax yourself with cotton swabs or other objects, as this can push wax deeper into the canal or damage your eardrum.
If you think you need a hearing aid, ask your doctor for a referral to an audiologist. Your doctor cannot fit a hearing aid, but an audiologist can test your hearing and recommend options. You will pay for the audiologist's services out of pocket.
Frequently Asked Questions
Does Medicare cover hearing aids at all?
Original Medicare does not cover hearing aids. Some Medicare Advantage plans do, but coverage varies by plan. Check your plan's Summary of Benefits and Coverage or call your plan to ask what hearing services are included.
Will Medicare pay for a hearing test if my doctor orders it?
It depends on why your doctor ordered the test. If it is medically necessary to diagnose a condition like sudden hearing loss or dizziness, Medicare may cover it. If it is only for fitting a hearing aid, it is not covered. Ask your doctor whether the test is diagnostic.
How much will I pay for earwax removal?
After you meet your Part B deductible, you pay 20% of Medicare's approved amount. The exact cost depends on the approved amount in your area. Call your doctor's office and ask what the approved amount is, so you can estimate your 20% share.
Can a nurse or audiologist remove my earwax under Medicare?
No. Medicare only covers earwax removal when a physician (MD or DO) performs it. A nurse practitioner or physician assistant cannot bill Medicare for this procedure, though they may information the doctor.
What if I have a Medicare Advantage plan that covers hearing aids?
Call your plan to confirm the coverage details: how much it pays, whether it covers one or both ears, and how often you can get new aids. Some plans require you to use specific audiologists or hearing aid providers, so ask about that too.