Does Medicare cover hearing tests?

What hearing tests does Medicare cover?

Medicare Part B covers diagnostic hearing and balance (fall risk) exams if your doctor or other health care provider orders them to find out if you need medical treatment. These exams evaluate your hearing and balance to diagnose or manage various conditions. CMS's Medicare Benefit Policy Manual describes audiological diagnostic testing as tests of the audiological and vestibular systems, like hearing, balance, auditory processing, tinnitus and diagnostic programming of certain prosthetic devices.

CMS's examples of reasons for ordering audiology tests that could be covered include:

• Evaluation of a suspected change in hearing, tinnitus or balance
• Evaluation of the cause of disorders of hearing, tinnitus or balance
• Determining the effect of medication, surgery or other treatment
• Failure of a screening test (although the screening test itself isn't covered)
• Diagnostic analysis of a cochlear or brainstem implant, and programming
• Audiology diagnostic tests before and periodically after implantation of auditory prosthetic devices

Can I see an audiologist without a doctor's order?

Yes, once every 12 months. You can visit an audiologist without an order from your health care provider, but only for:

• Non-acute hearing conditions, like hearing loss that happens over many years
• Diagnostic services related to hearing loss treated with surgically implanted hearing devices

What are the limits on seeing an audiologist without an order?

CMS's rule for this direct access, which applies to dates of service on and after January 1, 2023, allows care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting or changing hearing aids. Audiologists can bill for direct access once every 12 months per person. Medically reasonable and necessary tests that a physician or other practitioner orders, and that an audiologist personally provides, aren't affected by that once-every-12-months limit.

What do I pay for a hearing test with Medicare?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for a covered hearing or balance exam. In a hospital outpatient setting, you also pay the hospital a copayment. The specific amount you owe also depends on other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility and where you get the exam.

What hearing care doesn't Medicare cover?

Original Medicare doesn't cover hearing aids or exams for fitting hearing aids, so you pay all costs for them. CMS's Medicare Benefit Policy Manual also says Medicare doesn't pay for audiology diagnostic tests when:

• The type and severity of your current hearing, tinnitus or balance status needed to determine the appropriate medical or surgical treatment is known to the physician before the test, or
• The test was ordered for the specific purpose of fitting or modifying a hearing aid

Does Medicare Advantage or Medigap cover hearing tests?

Medicare Advantage plans must cover all medically necessary services that Original Medicare covers, and some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn't cover, like hearing; contact the plan for more information. A plan may require approval (prior authorization) before it covers certain services, and rules and costs vary by plan.

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. Medigap plans generally don't cover hearing aids. See Medicare and hearing aids.