Medicaid can cover hearing aids, but whether you qualify and what’s covered depends on your age and which state you live in. Children under 21 are guaranteed coverage in every state. Adults face a patchwork of rules that vary significantly from state to state. Here’s how the process works and what to expect.
Children Under 21 Are Fully Covered
If you’re getting a hearing aid for a child enrolled in Medicaid, federal law is on your side. The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit requires every state to provide hearing aids, hearing screenings, and diagnostic services to anyone under 21 on Medicaid. This isn’t optional for states. They must furnish all medically necessary services to correct or improve hearing conditions discovered through any screening or diagnostic procedure, even if those services aren’t part of the state’s standard adult Medicaid plan.
EPSDT coverage includes the hearing evaluation, the hearing aid itself, fitting, and follow-up care. If your child is on Medicaid and an audiologist determines they need a hearing aid, the state is required to provide it.
Adult Coverage Varies by State
For adults 21 and older, hearing aid coverage is not federally required. States choose whether to include it in their Medicaid plans. As of the most recent comprehensive survey by the Kaiser Family Foundation, roughly 28 states covered hearing aids for adults through their fee-for-service Medicaid programs. About 18 states did not, and a handful didn’t report.
Even in states that do cover hearing aids, there are often significant limits. Some states cap the number of hearing aids you can receive within a set period, such as one pair every three to five years. Others limit the type or cost of the device. Some require that your hearing loss meet a specific clinical threshold before they’ll approve coverage.
Your first step is to check your state’s Medicaid program directly. You can call the number on the back of your Medicaid card, visit your state’s Medicaid website, or contact your managed care plan if you’re enrolled in one. Ask specifically whether hearing aids are a covered benefit and what limits apply.
How to Qualify Medically
Beyond being enrolled in Medicaid, you typically need to meet a medical necessity standard. This means a licensed audiologist or physician must document that your hearing loss is significant enough to warrant a hearing aid. States set their own thresholds, but New York’s guidelines offer a useful example of how these criteria work in practice.
In New York, you generally qualify for a hearing aid if your better ear shows a hearing loss of 30 decibels or greater, averaged across three key speech frequencies (500, 1,000, and 2,000 Hz). If standard tone testing can’t be performed, a speech recognition threshold of 30 decibels or greater in the better ear can also qualify. Some states also cover cases where hearing is relatively normal at lower frequencies but drops to 40 decibels or worse at higher frequencies, which affects your ability to understand speech clearly even in quiet settings.
Your state may use different numbers, but the general principle is the same: you need a documented hearing loss that measurably affects your daily functioning.
The Step-by-Step Process
Getting a hearing aid through Medicaid follows a predictable sequence, though the details differ by state. Here’s the general path:
- Start with your primary care provider. In most states, you’ll need a referral from your primary care doctor or a physician to see an audiologist. Some states allow you to go directly to an audiologist, but a referral is the safest route to avoid claim denials.
- Get a full hearing evaluation. An audiologist will perform a series of tests, including air and bone conduction testing for both ears, speech reception threshold testing, and word discrimination scoring. These results form the basis of your hearing aid request.
- Prior authorization. Many states require prior authorization before a hearing aid can be dispensed. This means the audiologist or physician submits your test results and a request to Medicaid for approval before you receive the device. In New York, for example, this request includes the completed audiogram, speech test results, and the ordering provider’s signature. Requests can typically be submitted electronically or by mail.
- Fitting and dispensing. Once approved, you’ll return to the audiologist for the fitting. The provider will program the hearing aid to match your specific hearing loss pattern and make sure it fits comfortably.
- Follow-up adjustments. Most programs cover at least one follow-up visit to fine-tune the device after you’ve worn it for a few weeks.
The entire process, from your first appointment to receiving a hearing aid, can take anywhere from a few weeks to a couple of months, depending on how quickly prior authorization goes through in your state. If prior authorization is submitted after the device has already been dispensed due to unusual circumstances, New York’s program allows up to 90 days to submit the request with an explanation for the delay.
What Medicaid Covers Beyond the Device
A hearing aid isn’t a one-time expense. Batteries wear out, ear molds need replacing as ear canals change shape (especially in children), and the devices themselves occasionally need repairs. Coverage for these ongoing costs varies, but some states do include them. Colorado’s Medicaid program, for example, explicitly covers hearing aid batteries and replacement parts alongside the devices themselves.
Ear molds made for medical purposes are generally covered, but molds for non-medical uses like swimming or noise reduction typically are not. Cochlear implants and newborn hearing screenings are also covered in many states as separate audiology benefits.
If your state’s Medicaid program doesn’t cover batteries or repairs, ask your audiologist about low-cost battery programs. Many hearing aid manufacturers and nonprofit organizations offer discounted supplies to Medicaid recipients.
If Your State Doesn’t Cover Adult Hearing Aids
If you’re an adult in a state where Medicaid doesn’t cover hearing aids, you still have options. Some states cover the hearing evaluation even when they don’t cover the device, which at least gives you a documented diagnosis you can use elsewhere.
Medicaid managed care plans sometimes offer benefits beyond what the state’s fee-for-service program provides, so check with your specific plan. Beyond Medicaid, programs like the Hearing Loss Association of America’s resource directory, state vocational rehabilitation agencies, and Lions Club chapters can help connect you with free or low-cost hearing aids. Some hearing aid manufacturers also run patient assistance programs for people with limited income.
Income Eligibility for Medicaid Itself
If you’re not yet enrolled in Medicaid but think you might qualify, eligibility is based primarily on income. In states that expanded Medicaid under the Affordable Care Act, adults with income at or below 133% of the federal poverty level generally qualify. For children, coverage extends to at least 133% of the federal poverty level in every state, and most states set the threshold even higher for kids.
You can apply through your state’s Medicaid office or through HealthCare.gov during open enrollment. Medicaid applications are accepted year-round, so you don’t have to wait for an enrollment period. If you’re approved, hearing-related benefits typically begin as soon as your coverage is active.