Does Medicare cover cochlear implants?

If you’ve been suffering from hearing issues for some time, the doctor may have recommended that you consider cochlear implants. However, this procedure involves surgery, so you may be worried about the cost. That may leave you wondering if Medicare covers cochlear implants.

Read on to learn how Medicare handles these claims so you can be confident about your coverage.

Are cochlear implants covered by Medicare?

Medicare will cover some of the costs associated with cochlear implants. Coverage falls under Medicare Part B, which is dedicated to doctor services, outpatient care, preventive services, and medical supplies. 

When it comes to a cochlear implant, Medicare coverage considers it a prosthetic device that you may need to replace a bodily function. Therefore, it’s a covered claim when considered “medically necessary.” However, you will need to get a Medicare-enrolled doctor or health provider to recommend it first.

How much of the costs of cochlear implants are covered by Medicare?

Cochlear implants may cost anywhere between $30,000 and $50,000 on average. As there is Medicare coverage for cochlear implants, you may be able to get 80% of the amount approved by Medicare after you have met your Part B deductible.

You may need to talk with an agent to determine exactly how much Medicare will cover. The amount may vary from one individual to the next based on various factors, including the extent of your hearing problem and the kind of solutions you’ve looked at before considering this type of surgery. Also, you can only work with a provider recognized by Medicare and able to receive payments through the Medicare system.

Remember that when it comes to cochlear implants and Medicare coverage, Medicare will not necessarily meet the cost that an individual doctor or supplier intends to charge you.

In addition, Medicare administrators may have notional rates for this type of work and thus may only approve a portion of your doctor’s bill. In this case, you may be responsible for the difference. 

Will Medicare cover additional costs and accessories?

You may need ongoing support after your surgery, and Medicare might pay for clinical care or accessories that keep your implants functioning correctly. However, you may want to consider whether you can meet your ongoing costs out of your own pocket, as submitting a Medicare claim every time you need ongoing care may be challenging. 

Before having surgery, check with your provider about these ongoing costs and how your Medicare coverage will apply.

Will Medicare cover hearing aids instead of cochlear implants?

Some states insist that health insurance providers cover hearing aids for children and younger people, but often these aids are considered to be elective devices. Medicare does not currently offer coverage for hearing aids.

What are cochlear implants?

These implants are small electronic devices consisting of two separate portions. You have to place one behind the ear and need to get the other one surgically implanted underneath the skin. 

The design should improve your quality of life and enable you to experience sensations or sounds you would not otherwise have been able to. In this way, they are significantly more advanced than a standard hearing aid.

What are the pros and cons of cochlear implants?

As you can claim part of the cost for your cochlear implant through Medicare, you may want to weigh the pros and cons associated with this procedure, as reported by the U.S. Food and Drug Administration (FDA).

Some patients say they can hear completely different sounds and recognize distinct voices following the surgery. They may be able to watch TV without captions and enjoy music again. Others report post-surgery side effects such as infection, dizziness, bleeding, swelling, or ringing in the ear.

Case Studies on Medicare Coverage for Cochlear Implants

Case Study 1: Jane’s Medicare Coverage for Cochlear Implants

Jane, a 70-year-old Medicare beneficiary, has been experiencing severe hearing loss for several years. Her doctor recommended cochlear implants as a potential solution. Jane was relieved to find out that Medicare Part B would cover 80% of the cost of the procedure.

After meeting her Part B deductible, Jane was able to receive Medicare coverage for her cochlear implants, significantly reducing her out-of-pocket expenses.

Case Study 2: Mark’s Medicare Claim for Cochlear Implant Accessories

Mark, a 65-year-old Medicare beneficiary, recently underwent cochlear implant surgery. He was pleased to learn that Medicare not only covered the cost of the surgical procedure and the cochlear implant device but also certain accessories to ensure the proper functioning of his implants.

Medicare reimbursed Mark for clinical care and accessories related to his cochlear implants, helping him maintain his hearing health post-surgery.

Case Study 3: Sarah’s Medicare Limitations for Cochlear Implants

Sarah, a 68-year-old Medicare beneficiary, explored the possibility of getting cochlear implants to improve her hearing. However, she discovered that while Medicare covered a significant portion of the cost, it did not necessarily meet the full amount that her doctor intended to charge.

Medicare had its own approved rates for cochlear implant procedures, which could result in a difference that Sarah would be responsible for. She needed to carefully consider her costs and coverage before making a decision.

The Bottom Line on Medicare Insurance and Cochlear Implants

If a doctor or recognized healthcare provider recommends that you need cochlear implant surgery, you can file a claim through Medicare Part B. Once you have paid the deductible, Medicare will pay up to 80% of the cost of the procedure. 

Remember that the maximum Medicare will pay may be lower than the amount requested by the provider. Always examine your costs and coverage before committing to a procedure.