Why Doesn’t Medicare Cover Hearing Aids
Many of those seeking hearing aids in my office ask why doesn’t Medicare cover hearing aids. They are frustrated because for those who have Medicare, they have paid into a healthcare system that routinely provides at least some coverage for many medical procedures and services. While it is understandable that hearing aids, which are not inexpensive (costs range from approximately $1900 to upwards of $3800 depending on the office, area and manufacturer) may not be fully covered, it is a reasonable question to ask why Medicare doesn’t cover ANYTHING for them.
Other Covered Hearing Services
I am unaware of any publicly stated reason regarding why Medicare doesn’t cover hearing aids. However, a recent article titled “Why does Medicare cover cochlear implants but not hearing aid?” by hearing industry expert Dr. Fan-Gang PhD published in the September 2016 edition of The Hearing Journal offers 3 reasons as to why they might not covered:
- To be covered by Medicare, a device must provide a health benefit and “be determined to be reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member. Cochlear implants, which are a surgically implanted hearing device for those with severe hearing loss has been shown through scientific and clinical evidence to improve hearing and is a covered benefit by Medicare. Zeng states that “apparently, Medicare has determined that the published evidence on the health benefits of hearing aids is inadequate, and that, accordingly, hearing aids do not merit any coverage.
- Regulatory differences contribute to coverage disparities. Almost all pharmaceuticals and medically invasive Class-III medical devices have to be “proven” both safe and effective through comprehensive and expensive clinical trials required to obtain FDA approval. Hearing aids are regulated as lesser invasive medical devices and are exempted from rigorous controlled clinical trials to demonstrate health benefits. His opinion is that “achieving Medicare coverage will depend on the willingness and ability of hearing aid manufacturers to quantify the health benefits of hearing aids, which would be directly compared to other covered medical devices”.
- Medicare regulatory members are primarily composed of physicians who decide on what to cover as well as how much to cover. Hearing aid fitting does not require any surgery and hearing aids are dispensed by non-physicians (audiologists and hearing aid dispensers), seldom engaging physicians. In Dr. Zeng’s opinion, this lack of inter-relationship between the two professions has led to the present coverage disparity between cochlear implants and hearing aids.
To learn more about why doesn’t Medicare cover hearing aids, read Dr. Zen’s article or contact your local congress person.