Does Medicare Cover Cochlear Implants?

The American Cochlear Implant (ACI) Alliance explains that “a cochlear implant is an electronic medical device designed to restore the ability to perceive sounds and understand speech by individuals with moderate to profound hearing loss.”

Medicare recipients thinking about getting cochlear implants may be interested in these statistics captured by the National Institute on Deafness and Other Communication Disorders (NIDCD):

• As of December 2019, about 736,900 cochlear implants have been embedded globally. About 183,100 implant procedures have been performed in the U.S., which includes approximately 118,100 adults.
• For adults between the ages of 20 and 69, age is the strongest predictor of hearing deficiency, with the most prominent group for hearing loss in the 60-to-65 age bracket.

Cochlear implants versus hearing aids

The cochlea is the spiral-shaped area of the inner ear. The cochlear nerve transmits impulses to the brain’s hearing center. A damaged cochlea often leads to permanent hearing loss. 

• Hearing aids reside outside the ear and amplify sounds acoustically through the outer ear, middle ear and inner ear.
• A cochlear implant receives sound from an external transmitter behind your ear and sends electrical signals to the nerve fibers that are not damaged. The signals stimulate the auditory nerve, which in turn transmits these signals to the brain.

Cochlear implant procedures

Cochlear implant procedures are usually outpatient surgeries, which do not require an overnight stay. After about one month of healing, an audiologist programs the device and turns on the sound. 

Expect regular follow-up visits within the first year of the implant procedure. These visits ensure the device is updated so you can reap the optimum benefits. 

Medicare benefits for prosthetic devices

Part B Medicare benefits include prosthetic devices, which are artificial substitutes to replace damaged or missing body parts. Covered prosthetic devices include cochlear implants. Part B Medicare benefits also include outpatient surgeries and outpatient hospital services. 

Original Medicare will only cover prosthetic devices if you use suppliers enrolled in Medicare, regardless of which party files the claim. It does not cover hearing aids or any exams for hearing aid fittings. Medicare recipients enrolled in Medicare Advantage may have expanded benefits, depending on the policy. 

Cost of cochlear implants

With outpatient surgery and prosthetic items, you have the following cost-sharing responsibility:

• Part B deductible ($203 in 2021)
• 20% of the Medicare-approved amount
• Copayment to the facility where you go for outpatient surgery

The following are the national average amounts Medicare recipients pay for cochlear device implantation in 2021. These amounts include facility and physician fees:

• Ambulatory surgical center: $6,600
• Hospital outpatient department: $1,735

Resources

You may want to include these resources in your research about hearing loss and cochlear implants:

• NIDCD Information Clearinghouse: 800-241-1044
• Journal of the American Academy of Audiology
• ACI Alliance: 703-534-6146