Medicare covers the cost of a hearing evaluation if your doctor orders it for a medical reason, but only the evaluation itself — not the hearing aid that may follow
Original Medicare (Part B) pays 80 percent of the cost of a diagnostic hearing evaluation when a physician or other may have access to healthcare provider refers you for one. You pay the remaining 20 percent after you meet your Part B deductible. The evaluation must be ordered by a doctor as part of diagnosing or treating a medical condition — not straightforward because you want to know if you need hearing aids.
The distinction matters because Medicare does not cover hearing aids themselves, their fitting, or routine hearing tests done for the purpose of selling you a device. If you go to a hearing aid store and ask for a test, that test is not covered. If your doctor orders an evaluation to determine whether hearing loss is caused by an infection, medication side effect, or another treatable condition, that evaluation is covered.
Medicare Advantage plans (Part C) may offer different coverage for hearing services, including some that cover hearing aids or evaluations beyond what Original Medicare provides. Check your plan's coverage document or call the plan directly to learn what it covers in your case.
Key Takeaways
- Original Medicare covers a hearing evaluation ordered by your doctor as part of medical diagnosis or treatment, with you paying 20 percent after your deductible.
- Routine hearing tests done at a hearing aid store or for the purpose of fitting hearing aids are not covered by Medicare.
- Medicare does not cover the cost of hearing aids, their fitting, or adjustments, regardless of how the evaluation was ordered.
- Medicare Advantage plans sometimes cover hearing aids or additional hearing services, so review your plan's details or contact the plan to confirm what you have.
- Your doctor must order the evaluation for it to be covered — you cannot self-refer to an audiologist and expect Medicare to pay.
When Medicare will pay for a hearing evaluation
Your doctor must order the evaluation and document a medical reason for it. Common reasons include sudden hearing loss, hearing loss in one ear only, dizziness or balance problems alongside hearing changes, ear pain, discharge from the ear, or hearing loss that may be caused by medication you are taking. The evaluation is meant to diagnose the cause, not to fit you for a device.
The provider who performs the evaluation must be a physician, audiologist, or other may have access to healthcare professional. The evaluation typically includes a hearing test (audiometry), sometimes balance testing, and a physical exam of the ear. If the provider finds a treatable cause — such as earwax impaction, infection, or medication side effect — that discovery and any follow-up treatment may also be covered.
The evaluation must take place in a medical setting, not a retail hearing aid store. Hospital audiology departments, ear, nose, and throat (ENT) offices, and independent audiology clinics that bill Medicare as medical providers all may have access to.
What Medicare does not cover
Hearing aids themselves are not covered by Original Medicare, even if a covered evaluation shows you need one. The device, the fitting appointment, the adjustment visits, the batteries, and the repairs are all your responsibility. Some people pay $1,000 to $6,000 per hearing aid, depending on the technology.
Routine hearing tests done for the purpose of fitting hearing aids are not covered. If you walk into a hearing aid store and ask for a test, or if a store offers you a "free hearing test," that test is not a Medicare-covered service. The difference is the intent: a covered evaluation diagnoses a medical condition; a routine test screens for hearing aid candidacy.
Hearing aid dispensing, programming, and follow-up care are not covered. Neither are cochlear implants or other implantable hearing devices, though some Medicare Advantage plans may cover them.
How to get a covered hearing evaluation
Start by scheduling an appointment with your primary care doctor or an ear, nose, and throat specialist. Tell them you have noticed hearing changes and describe what you have observed — whether it is gradual or sudden, whether it affects one ear or both, and whether it is accompanied by other symptoms like ringing, dizziness, or ear pain.
Your doctor will examine your ear and may order a formal hearing evaluation if they think one is medically necessary. They will send the referral to an audiologist or audiology clinic that accepts Medicare. Make sure the provider you are referred to is in-network for your plan (if you have a Medicare Advantage plan) or accepts Medicare assignment (if you have Original Medicare).
At the evaluation appointment, bring your Medicare card and any referral paperwork your doctor provided. The provider will perform the hearing test and other diagnostic procedures. After the evaluation, your doctor will receive a report of the results and can discuss next steps with you — which may include treatment for a medical cause, a referral to an ENT specialist, or information about hearing aids if that is appropriate.
What you will pay
With Original Medicare, you pay 20 percent of the Medicare-approved amount for the evaluation after you have met your Part B deductible ($240 in 2024, though this amount changes yearly). The actual amount you owe depends on what the provider charges and what Medicare considers reasonable for your area.
If you have a Medicare Advantage plan, your cost depends on your plan's rules. Some plans charge a copay for specialist visits; others charge coinsurance (a percentage of the cost). Check your plan documents or call the plan's customer service number to learn your out-of-pocket cost before you schedule the appointment.
If the evaluation reveals a treatable medical condition — such as an infection or earwax impaction — any follow-up treatment ordered by your doctor may also be covered under Medicare's rules for that treatment.
Medicare Advantage and hearing coverage
Some Medicare Advantage plans include coverage for hearing aids, hearing evaluations beyond what Original Medicare covers, or both. A few plans cover one hearing aid per ear every year or every two years. Others cover the evaluation but not the device. Coverage varies widely by plan and by year.
To find out what your plan covers, check the "Hearing Services" or "Hearing Aids" section of your plan's Summary of Benefits and Coverage document, which you received when you enrolled. You can also call the plan's customer service number and ask specifically: "Does my plan cover hearing aids? Does it cover hearing evaluations? If so, what is my copay or coinsurance?"
If your current plan does not cover hearing aids but you want that coverage, you can switch to a different Medicare Advantage plan during the Annual Enrollment Period (October 15 to December 7 each year) or during a Special Enrollment Period if you may have access to.
Alternatives if Medicare does not cover what you need
If you need a hearing aid and Medicare does not cover it, several options exist. Some hearing aid manufacturers offer payment plans or discounts for people without insurance coverage. Costco, Sam's Club, and other retailers sell hearing aids at lower prices than traditional hearing aid dispensers. Some of these devices are over-the-counter and do not require a prescription or fitting.
State vocational rehabilitation programs sometimes cover hearing aids for working-age adults. Veterans may have coverage through the VA. Some nonprofit organizations and community health centers offer reduced-cost or sliding-scale hearing aid services. Your doctor or local Area Agency on Aging can point you toward programs in your region.
Over-the-counter hearing aids became available in 2022 for mild to moderate hearing loss and cost significantly less than prescription devices — typically $500 to $1,500 per pair. They do not require a doctor's order or professional fitting, though some people find professional guidance helpful.
Frequently Asked Questions
Do I need a referral from my doctor to get a hearing evaluation covered?
Yes. Your doctor must order the evaluation for Medicare to cover it. You cannot self-refer to an audiologist and expect Medicare to pay. The order must document a medical reason — not straightforward a desire to know if you need hearing aids.
Will Medicare pay if I go to a hearing aid store for a hearing test?
No. Tests done at hearing aid stores are not covered by Medicare because they are not ordered by a doctor for a medical reason. They are screening tests meant to sell you a device. A covered evaluation must be ordered by your doctor and performed in a medical setting.
If my hearing evaluation shows I need hearing aids, will Medicare pay for them?
Original Medicare does not cover hearing aids under any circumstances. If you have a Medicare Advantage plan, check your plan documents or call customer service to see if it covers hearing aids. Some plans do; most do not.
What if I have both Original Medicare and a Medigap plan — does Medigap cover hearing aids?
No. Medigap plans fill gaps in Original Medicare coverage, but because Original Medicare does not cover hearing aids, Medigap plans do not cover them either. Only some Medicare Advantage plans offer hearing aid coverage.
Can I get a hearing evaluation covered if I have not seen my doctor in years?
Yes, but you will need to schedule an appointment with your doctor first. Explain that you have noticed hearing changes. Your doctor will examine you and decide whether a formal evaluation is medically necessary. If it is, they will order one.