Does Medicare cover cochlear implants?

How does Medicare cover cochlear implants?

Medicare.gov lists cochlear implants among the surgically implanted prosthetic devices Medicare covers, and either Part A or Part B covers a surgically implanted prosthetic device depending on whether the surgery takes place in an inpatient or outpatient setting. CMS describes a cochlear implant device as an electronic instrument, part of which is implanted surgically to stimulate auditory nerve fibers, and part of which is worn or carried to capture, analyze and code sound.

CMS's Medicare Benefit Policy Manual says certain devices that produce perception of sound by replacing the function of the middle ear, cochlea or auditory nerve are payable as prosthetic devices, and lists cochlear implants, auditory brainstem implants and osseointegrated implants among them. These devices are indicated only when hearing aids are medically inappropriate or can't be used because of congenital malformations, chronic disease, severe sensorineural hearing loss or surgery.

Who qualifies for a Medicare-covered cochlear implant?

Under CMS's national coverage determination for cochlear implantation (NCD 50.3), effective for services on or after September 26, 2022, cochlear implantation may be covered for treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in people who demonstrate limited benefit from amplification. CMS defines limited benefit from amplification as test scores of 60% correct or less in the most favorable aided listening condition on recorded tests of open-set sentence recognition. You must meet all of these criteria:

• A diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids
• The cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation
• Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system
• No contraindications to surgery
• The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling

What do I pay for a cochlear implant with Medicare?

For a Part B-covered prosthetic device, you pay 20% of the Medicare-approved amount after you meet the Part B deductible ($283 in 2026). Medicare only pays for a prosthetic device from a supplier that participates in Medicare, whether you or your provider submits the claim.

What else you pay depends on where the surgery takes place:

• As a hospital outpatient: you usually pay 20% of the Medicare-approved amount for the doctor's services, and you also usually pay the hospital a copayment for each service you get in a hospital outpatient department.
• As a hospital inpatient: Part A usually covers inpatient hospital care when you're admitted as an inpatient with a doctor's order saying you need inpatient hospital care to treat your illness or injury, and the hospital accepts Medicare. In 2026 you pay the $1,736 Part A deductible for each benefit period, then $0 each day for days 1-60, and Part B generally covers 80% of the Medicare-approved amount for doctors' services you get while you're in the hospital.

What if I don't meet Medicare's cochlear implant criteria?

People with Medicare who don't meet all of the coverage criteria are not eligible for Medicare coverage of cochlear implantation, with one exception. CMS may cover cochlear implants for people who don't meet the criteria when the implant is performed in the context of FDA-approved category B investigational device exemption clinical trials, or as a routine cost in clinical trials under CMS's national coverage determination for routine costs in clinical trials. See Medicare and clinical trials.

Does Medicare cover hearing tests and programming for a cochlear implant?

Yes, when the tests are ordered for a covered reason. CMS's Medicare Benefit Policy Manual lists diagnostic analysis of a cochlear or brainstem implant and programming, and audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices, among the reasons for ordering audiology tests that could be covered. You can also visit an audiologist once every 12 months without an order for diagnostic services related to hearing loss treated with surgically implanted hearing devices. See Medicare coverage for hearing tests.

The same manual says supplies necessary for the effective use of a prosthetic device are covered, and adjustments of prosthetic devices required by wear or by a change in your condition are covered when a physician orders them.

Does Medicare Advantage or Medigap change cochlear implant coverage?

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and a plan may require approval (prior authorization) before it covers certain services or supplies; out-of-pocket costs vary by plan. In Original Medicare, a Medigap (Medicare Supplement Insurance) policy helps cover your share of costs, like copayments, coinsurance and deductibles, for services Original Medicare covers, and the benefits are different in each plan. Hearing aids remain uncovered by Original Medicare; see Medicare and hearing aids.