Does Medicare Cover Cochlear Implants?

Medicare and other federal health programs provide at least some coverage for cochlear implants.

Qualifying for Medicare coverage depends in large part on the severity of your hearing loss and whether other methods, such as hearing aids, have been unsuccessful in treating your condition.

Cochlear implants are not hearing aids. Original Medicare does not cover hearing aids.

Generally, a cochlear implant is covered by Medicare if you recognize sentences while wearing your hearing aids only 40% of the time or less.

Three companies manufacture FDA-approved cochlear implant devices: Cochlear, Advanced Bionics Corp. and MED-EL Corp.

In 2022, Medicare updated its national coverage determination to cover cochlear implantation for those who test at less than or equal to 60% correct on aided, recorded tests of open-set sentence cognition and meet all other eligibility requirements.

Previously, if you scored between 41% and 60% on a hearing test you could be eligible for Medicare coverage only if your provider participated in an approved cochlear implant clinical trial.

If you meet Medicare’s criteria for cochlear implants, you may still owe some money out-of-pocket.

Medicare considers cochlear implants a prosthetic device covered under Medicare Part B.

You will likely owe 20% for the Medicare-approved cost of the device, and the Part B deductible applies.

You may owe less if you have supplement insurance, such as Medicaid or a Medigap policy.

Medicare Advantage plans must offer the same basic benefits as Original Medicare (Part A and Part B), but many offer additional benefits.

If you’re enrolled in a Medicare Advantage plan, check with your plan provider to learn more about its coverage of cochlear implants. Prior authorization may be required.

Most surgeons who perform cochlear implants have insurance experts on staff who can help you navigate your plan’s rules and answer questions.

Cochlear implant monitoring — including remapping and reprogramming — as well as rehabilitation following your surgery is usually covered as an outpatient rehabilitation therapy benefit.

Check your specific plan or ask an insurance expert at your surgeon’s office for more information about any out-of-pocket costs for follow-up care and rehabilitation.

Cochlear implants are small devices surgically implanted inside your ear to stimulate the auditory nerve with electrical currents.

They bypass hair cells inside the ear and directly transmit sounds through multiple electrodes.

The purpose of implanting the device is to provide awareness and identification of sounds for people who are moderately to profoundly hearing impaired.

Cochlear implants are available in single-channel and multi-channel models.

According to the Centers for Medicare and Medicaid Services, you will need to return to the implanting center four to five weeks after post-surgery healing to get your speech processor programmed.

The number of visits needed to properly optimize your device depends on several factors, including your age and cognitive skills.

Because your response to nerve stimulation may change, you’ll need long-term follow-up after your procedure.