Plans We Work With

Coverage for hearing care varies by carrier and by individual plan, so the fastest way to get a real answer is to let us check it for you.

Medicare and Hearing Care

Original Medicare (Parts A and B)

Original Medicare does not cover hearing aids or the exams to fit them. That surprises most people, and it is the single most common misunderstanding we hear in our office.

Medicare Part B does cover diagnostic hearing and balance exams when your provider orders the test to help determine your medical treatment. In that situation you are generally responsible for the Part B deductible and coinsurance, and for a copayment as well if the test is done in a hospital outpatient setting.

Medigap (Medicare Supplement) policies follow Original Medicare, so they generally do not add hearing aid coverage either.

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers and are required to cover everything Original Medicare covers. Many of them go further and include a routine hearing benefit, often an allowance toward hearing aids through a specific network of providers.

Because these benefits are set plan by plan, the only reliable answer comes from checking your particular plan. Bring your card to your appointment or call us ahead of time and we will look into it with you.

Read Medicare's own page on hearing aid coverage or its page on hearing and balance exams.

Employer and Private Insurance

Private and employer-sponsored plans handle hearing very differently from one another. Some cover a hearing evaluation but nothing else. Some include a hearing aid allowance every three to five years. Some route the hearing aid benefit through a separate administrator with its own network and its own device pricing.

Common things worth knowing about your own plan before you shop:

• Whether a hearing evaluation is covered, and whether it needs a referral from your primary care provider
• Whether there is a hearing aid allowance, and how often it renews
• Whether the benefit is administered by the carrier directly or by a third-party hearing network
• Whether you must use a specific provider or device list to get the benefit

If you are not sure where to start, call the member services number on the back of your card and ask those four questions. Or bring the card to us and we will make the call with you.

Pennsylvania Medical Assistance (Medicaid)

Pennsylvania's Medical Assistance program covers hearing services for children and young people under 21 through the EPSDT benefit, which is broad by design.

For adults 21 and over, hearing coverage depends on the specific HealthChoices managed care plan the member is enrolled in, and it is not the same across plans. We will not guess at your benefit here. Call us with your Medical Assistance card and the name of your managed care plan, and we will help you find out what it actually covers.

Using an HSA or FSA

Paying Without Insurance Coverage

Plenty of our patients pay for hearing aids without any insurance benefit at all, and that is a normal way to do this. What matters is knowing the full cost up front — the devices, the fitting appointments, the follow-up adjustments and the aftercare — before you commit to anything.

We will always give you that number in writing, and we will never pressure you into a decision in the same visit as your hearing test.

We are happy to walk through the payment options available to you at your appointment, so you can decide with the whole picture in front of you.

What to Bring to Your First Visit

• Your insurance card, or cards if you carry more than one
• A photo ID
• A referral from your primary care provider, if your plan requires one
• A list of your current medications
• If you can, someone who knows your hearing — a spouse, an adult child, a close friend. A second perspective is genuinely useful.

New to us? Start with a comprehensive hearing test, or read about the hearing aids we fit and how fittings work.

Insurance Questions We Hear Every Week