Hearing Loss and Medicare - Is change coming?

by Envoy Medical Staff Member, on April 30, 2021


While you may not be a Medicare recipient now, studies show that Medicare exerts a substantial influence over the rates private insurers pay. Today, Medicare coverage is available to those 65 years and older and those who have a qualifying disability.

One-quarter of Americans aged, 65-74 have hearing loss and 50% of those who are 75 and older have disabling hearing loss. Disabling hearing loss in adults is defined as a hearing loss greater than 40 dB in the better hearing ear and does not include those with hearing loss in one ear.

Yet Medicare has had a hearing aid exclusion since it was established in 1965. 

What is the Hearing Aid Exclusion?

The Hearing aid exclusion allows Medicare to avoid covering hearing aids, hearing exams, or hearing aid fittings. Those on Medicare and struggling with hearing loss are responsible for 100% of these costs.

If a primary provider orders diagnostic hearing and balance exams, the exams will be covered by Part B. However, when they find hearing loss and your treatment option is a type of hearing aid you are on your own.  Even Medigap plans won’t help as they follow what Medicare does.

Unfortunately, the hearing aid exclusion has also allowed Medicare to label many different types of treatment options such as middle ear implants as “hearing aids” making it impossible for those to even attempt to make a case for coverage if traditional hearing aids don’t work for them. In fact, this blanket exclusion also has an impact on innovation as companies with new ideas are unable to attempt coverage for those ideas.

 Medicare Advantage plans are the only plans that may cover some of the costs of hearing aids, however, there are a lot of restrictions with most offering limited coverage once every five years.

In the fifty years since Medicare was established ( 56 to be exact), research into the effects of untreated hearing loss has expanded showing many correlations between untreated hearing loss and significant health issues. Dr. Frank Lin at John Hopkins touches on just some of the risks of hearing loss here.

What might change this?

Introduced on July 26, 2019, the Medicare Hearing Aid Coverage Act of 2021 (Now H.R. 1118) would remove the hearing aid and examinations exclusion. This bill would help improve access to treatment and removing the hearing aid exclusion will also help open it up to other hearing technologies.  This bill also directs the Government Accountability Office to conduct a study on insurance programs that provide services to help with hearing loss.  While this bill is gaining support more advocacy will be needed to see it through.  At the time of this writing, the bill is gathering bipartisan support and currently has 17 signatures.

Dr. Shohet

Jack Shohet - FINAL

Winning an Oscar for Sound and Highlighting Hearing Loss

The Sound of Metal, directed by Darius Marder is creating a lot of conversation around hearing loss and just won an Oscar for the Sound category.  The story follows a heavy metal drummer whose life is suddenly thrown into chaos when he begins to lose his hearing.  The movie has been praised for its realistic portrayal of what it's like to experience hearing loss, hence the Oscar for sound. However, many professionals and CI users have expressed frustration over the negative portrayal of cochlear implants and the lack of appropriate counseling.

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