Unfortunately, when it comes to vision, dental and hearing care, traditional Medicare doesn’t offer much coverage for older adults.
If you have supplemental insurance, however, it may pay for some or all of these services, depending on your plan.
What is Medicare?
Medicare is a federal health insurance program that covers people who are 65 or older, as well as younger people with disabilities or serious diseases. However, Medicare does not cover all costs of medical services, which is where the rule becomes difficult. There are a number of factors affecting coverage, so it is imperative you take the different kinds of coverage available into consideration.
Are hearing aids covered by Medicare?
No. Medicare is very clear about this on their website:
“Medicare does not cover hearing aids or check fitting hearing aids. You pay 100% for hearing AIDS and exams. Some Medicare Advantage Plans (Part C) provide additional benefits that consider basic Medicare cover – such as vision, hearing or dental treatment. For more information contact the plan.”
Why doesn’t Medicare cover hearing care?
As this clinical review explains, “The Medicare Act of 1965 statutorily excluded coverage of hearing aids under the premise that they were ‘routinely needed and low in cost,’ suggesting that consumers would be responsible for their purchase.” Also, at the time, many seniors didn’t live as long as they do today, and so fewer people had age-related hearing loss. There also was little understanding of how important it is to treat hearing loss to reduce depression and social isolation.
Will coverage on hearing aids change?
Over the years, many organizations and lawmakers have tried to update Medicare to cover vision, hearing and dental costs for seniors.
Many people would like to see Medicare evolve to cover dental, vision and hearing care. A Commonwealth Fund report details the financial and health burdens these gaps place on older adults. The report said:
“Among Medicare beneficiaries, 75 percent of those who needed a hearing aid did not have one; 70 percent of people who had trouble eating due to their teeth have not been to the dentist in the past year; And 43 percent of the people who had trouble seeing, have not had their eyes examined in the last one year.”
However, so far, no one has been successful at getting changes made to this part of Medicare coverage. In the summer of 2019, several U.S. representatives introduced H.R. 4056, a bill that would require Medicare to pay for certain audiological services. Time will tell if this bill gets passed.
What do all the Medicare ‘parts’ mean?
Here’s a breakdown:
Medicare Part A: Hospital insurance
Nursing home care
Home health services
Skilled nurse facility care
Medicare Part B: Medical insurance
Medicare Part B covers two types of services: medically necessary and preventative services. Preventative services include early detection of an illness. Most of these services are provided at no cost for people with Part B coverage.
Durable medical equipment
Inpatient, outpatient and partial hospitalization for mental illness
Seeing a second doctor before surgery
Some outpatient prescription drugs
Medicare Part C: Medicare Advantage Plans
This plan is a healthcare option that is run by a private insurance company under contract with Medicare. The Advantage Plan usually includes coverage of all parts of Medicare. In some cases, the private insurer may pay for hearing exams. You should check with your plan provider if you have Part C coverage. If you also have supplemental coverage not related to Part C, again you should check with your provider.
Medicare Part D: Drug plan coverage
Medicare prescription drug plans each have a list of available medications. The drugs are separated into different tiers based on your out-of-pocket costs for each. Drugs that are listed in the lower tiers will cost you less than a drug in a higher tier. The drug plans have specific coverage rules laid out that need to be considered as well.
What other items are not covered by Medicare?
Besides hearing aids and fitting exams, there are many other medical expenses not paid for by Medicare. They include:
Long-term or custodial care
What about screenings covered by Medicare?
Medicare covers screening services and preventative tests under the Medicare Part B plan. These include shots for flu, hepatitis B and pneumococcal. In addition, it will cover a yearly wellness visit.
Other services covered by Medicare:
Abdominal aortic aneurysm screening
Bone mass measurements
Cardiovascular disease screenings and behavioral therapy
Cervical and vaginal cancer screenings
Diabetes screenings and self-management training
Prostate cancer screenings
Sexually transmitted disease screenings and counseling
Medicare Part B also covers health screenings for alcohol abuse, obesity, nutrition therapy and depression.