Original Medicare does not cover routine annual hearing tests. It does, however, cover diagnostic hearing exams when there’s a medical reason for the test. The distinction between “routine” and “diagnostic” is the key to understanding what Medicare will and won’t pay for.
What Medicare Actually Covers
Medicare Part B covers hearing and balance exams that are medically necessary, meaning a doctor or other provider has identified a reason to check your hearing beyond a simple wellness screening. If you’re experiencing symptoms like sudden hearing loss, ringing in your ears, or difficulty understanding speech, a diagnostic hearing test ordered to investigate those symptoms is generally covered. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount. If the test happens in a hospital outpatient setting, you’ll also owe a copayment to the hospital.
The word “diagnostic” is doing a lot of work here. A hearing test is the same test whether it’s called routine or diagnostic. The difference is why it’s being done. If your doctor orders it to evaluate a specific complaint or monitor a known condition, Medicare treats it as diagnostic and covers it. If you simply want your hearing checked as part of an annual wellness routine with no symptoms or medical concern documented, Medicare considers that routine and won’t pay.
Direct Access to Audiologists
Starting in 2023, Medicare created an exception to its usual requirement that a physician order all audiology services. Once every 12 months, you can see an audiologist directly, without a doctor’s referral, for certain diagnostic hearing tests. This applies to non-acute hearing conditions but does not include tests for dizziness or balance problems.
This is a meaningful change. Previously, you’d need to visit your primary care doctor first, describe your symptoms, get a referral, and then schedule a separate appointment with an audiologist. Now you can go straight to the audiologist if you’ve noticed changes in your hearing. The test still needs to be diagnostic in nature, not a routine screening, but the barrier to getting one is lower than it used to be.
Hearing Aids Are Not Covered
Even when Medicare pays for the diagnostic test, it does not cover hearing aids. This is one of the most significant gaps in Original Medicare’s benefit structure. If your test reveals hearing loss that would benefit from amplification, you’re responsible for the full cost of hearing aids out of pocket.
There is one notable exception on the device side: cochlear implants. Medicare covers cochlear implantation for people with moderate-to-profound sensorineural hearing loss in both ears who get limited benefit from traditional hearing aids. This coverage has been in place for years and was updated in 2022 to refine the eligibility criteria.
Over-the-counter hearing aids, which the FDA authorized for mild to moderate hearing loss, are also not covered or reimbursed by Original Medicare. They typically cost significantly less than prescription hearing aids, ranging from a few hundred to about $1,500 per pair, but the expense is entirely yours under traditional Medicare.
Medicare Advantage Plans Often Include Hearing Benefits
Medicare Advantage (Part C) plans frequently offer hearing benefits that go beyond what Original Medicare provides. Many cover routine hearing exams, and a growing number include partial or full coverage for hearing aids. The specifics vary widely by plan. Some offer an annual hearing screening at no extra cost, while others provide an allowance toward hearing aids every few years.
If hearing coverage matters to you, it’s worth comparing Medicare Advantage plans in your area during open enrollment. Look at whether the plan covers routine screenings (not just diagnostic exams), what the hearing aid benefit looks like, and whether you’re limited to specific providers or brands. These supplemental hearing benefits are one of the main reasons people choose Advantage plans over Original Medicare.
Medigap policies, the supplemental plans designed to fill gaps in Original Medicare, generally do not cover hearing aids or routine hearing exams. They help with copays and deductibles on services Medicare already covers, but they don’t add new categories of benefits.
Medicaid and Dual Eligibility
If you qualify for both Medicare and Medicaid (known as being “dual eligible”), your state’s Medicaid program may cover hearing services that Medicare doesn’t. About 28 states provide some form of Medicaid coverage for hearing assessments and hearing aids for adult beneficiaries. The catch is that eligibility criteria and the scope of benefits vary significantly from state to state. There are no federal requirements for states to cover adult hearing health care under Medicaid, so your coverage depends entirely on where you live.
How to Get a Covered Hearing Test
The most practical path to a Medicare-covered hearing test is to talk with your doctor about any changes you’ve noticed in your hearing. Difficulty following conversations in noisy environments, asking people to repeat themselves more often, or turning the TV volume higher than you used to are all legitimate concerns worth mentioning. When your doctor documents a medical reason and orders a hearing evaluation, or when you access an audiologist directly for a non-acute hearing concern, Medicare will typically cover the test.
You can also bring up hearing concerns during your Annual Wellness Visit, which Medicare does cover. Your provider can screen for hearing issues during that visit and, if warranted, refer you for a full diagnostic evaluation. That referral creates the medical justification Medicare requires, turning what might otherwise be categorized as a routine test into a covered diagnostic one.