Does Medicare Cover Cochlear Implants?
Yes. because Original Medicare considers cochlear implants a prosthetic device covered under Medicare Part B, it’ll help pay for 80% of the cost if you meet the eligibility requirements. Medicare Advantage (Part C), must offer the same coverage as Original Medicare — which means you will be covered under a Part C plan with the same requirements.
Whether you’re eligible for coverage will depend on how severe your hearing loss is and whether other medical devices such as hearing aids have been successful in treating your condition.
Table of Contents
What Are Cochlear Implants?
A cochlear implant is an electronic medical device that replaces the function of an impaired inner ear, allowing people who are deaf or hard of hearing to perceive sounds. Here are the four basic components of a cochlear implant to help you better understand how the device works.
- Microphone: The microphone on the speech processor captures sound signals from the environment and sends them to its speech processor.
- External speech processor: The external speech processor arranges sounds picked up by the microphone.
- Transmitter and receiver: The transmitter and receiver convert sound signals from the speech processors into electric impulses.
- Implanted electrodes: The electrode array implanted in the cochlea then collects the electric impulses and sends them to various regions of the auditory nerve.
Though cochlear implants will not completely restore hearing, they can help you recognize sounds and better understand speech. Unfortunately, the high price tag of these devices can put them out of reach for many people, which is why Medicare coverage for cochlear implants is crucial, as it allows more deaf and hard-of-hearing individuals to access this life-changing technology.
Understanding Medicare Coverage for Cochlear Implants
Medicare Part B considers cochlear implants prosthetic devices and will cover 80% of the costs as long as they’re deemed medically necessary by your doctor.
Before 2022, cochlear implants were only covered by Original Medicare if you recognize sentences 40% of the time or less while wearing your hearing aids. However, Medicare updated this requirement to cover cochlear implants for those who score 60% or lower on recorded tests of open-set sentence cognition.
Eligibility
As of 2023, you must meet the following eligibility criteria to receive cochlear implant coverage from Medicare:
- Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from hearing aids. Limited benefit is defined as testing 60% or lower on recorded tests of open-set sentence cognition.
- 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.
If you’re unclear about any of these requirements, talk to your physician for help.
How Does Medicare Advantage Cover Cochlear Implants?
Medicare Advantage is a type of health insurance plan offered by Medicare-approved private insurance companies. It provides the same coverage as Original Medicare but also includes additional benefits Medicare Part A and Part B does not provide, such as vision, dental, hearing, and prescription drug coverage.
Since MA plans cover, at a minimum, everything Original Medicare covers, they also offer coverage for cochlear implants. With that said, check with your specific Medicare Advantage Plan provider for coverage information, as it could vary depending on the insurer.
How Much Do Cochlear Implants Cost With Medicare?
Cochlear implants can come with a hefty price tag that could put a dent in your wallet. Without insurance, cochlear implants, including the device, surgery, and rehabilitation, can range from $50,000 to $100,000.
The good news is that Medicare Part B can help you shoulder 80% of these costs. This coverage will include more than just the surgery, also helping pay for testing, rehab, and more. Once you meet your Part B deductible of $226 and pay your standard monthly premium of $164.90, you’re only responsible for 20% of the Medicare-approved cost.
Take a look at the table below for an example scenario of how much a cochlear implant may cost if the total expense of getting the implant is $50,000.
Medicare Part B Deductible | Cochlear Implant Total Cost After Deductible | What Medicare Covers | Your Part of the Implant | Your Total Cost |
|---|---|---|---|---|
$226 | $49,774 | 80% of the total cost: $39,819.20 | 20% of the total cost: $9,954.80 | $10,180.80 |
How Medigap Can Help
With cochlear implants that range from $50,000 to $100,000, your out-of-pocket costs can still be quite steep even with Original Medicare coverage. If you cannot afford to shell out five figures for cochlear implants, consider looking into Medigap, an extra health insurance plan you can purchase from private insurers to cover deductibles, coinsurance, and copayments.
The Cost With Medicare Advantage
Cochlear implants’ out-of-pocket costs, including premiums, deductibles, and copayments, vary depending on your Medicare Advantage plan provider.
However, unlike Original Medicare, Medicare Advantage plans have an annual maximum out-of-pocket spending limit for services covered under parts A and B, which is $8,300 as of 2023. So, your out-of-pocket costs should not exceed that limit as long as you seek care from in-network providers.
How Medicare Covers Hearing Care
While Medicare may offer coverage for cochlear implants, they typically do not cover hearing aids or exams for fitting them. This is because cochlear implants are considered prosthetic devices, whereas hearing aids are not categorized the same way. In other words, you’re responsible for 100% of the related costs, which can be anywhere from $1,000 to $5,000.
If you need extensive hearing care but cannot afford the expenses, look into Medicare Advantage Plans.
Because MA plans include additional benefits that Medicare Part A and Part B does not offer, some may provide additional coverage for diagnostic hearing tests, hearing aids, and other hearing care services.
Other Financial Options for Covering Cochlear Implants
Consider these financial options for covering cochlear implants if you’re not eligible for Medicare coverage:
- Medicaid: Medicaid is a government program that provides health insurance for those with limited income. Most state Medicaid programs provide coverage for cochlear implants, so contact your local Medicaid office for specific details.
- Veterans Affairs (VA): Many veterans suffer from hearing loss due to their military experience. In response, the Veterans Affairs (VA) offers cochlear implants as part of their comprehensive hearing loss treatment.
- Nonprofit Organizations: Some nonprofit organizations, such as the Cochlear Implant Awareness Foundation (CIAF), may offer financial aid programs for those needing cochlear implants but cannot afford the high costs.
- Private Health Insurance: Most private health insurance policies provide full or partial coverage for cochlear implants. But remember that coverage can vary depending on the specific insurance plan, so check with each insurer for more details.
Putting It All Together
Cochlear implants can be life-changing if you suffer from complete or partial hearing loss. While the implant will not restore your hearing to normal, it can still significantly improve your quality of life by helping you recognize more sounds and understand speech. And with Medicare Part B offering to cover 80% of the costs, you do not have to worry about incurring financially devastating medical debt to pay for the procedure.
If you still need financial assistance with out-of-pocket expenses like deductibles, copayments, and coinsurance, look into Medigap policies to alleviate your financial pressure.