Does Medicare Cover Hearing Tests for Tinnitus?

Medicare Benefits Solutions

Dec 15, 2022

Medicare normally doesn’t cover the cost of audiological services such as hearing aids or routine hearing tests. However, Medicare Part B may provide coverage for a diagnostic hearing and balance exam if your doctor determines the test is medically necessary.

Medicare Coverage of Audiologic Diagnostic Testing

If you’re experiencing a change in your hearing, you may be wondering if it’s time to see your doctor. Some people who notice a gradual decline in hearing may put off getting a hearing test until it’s affecting their quality of life, but it can be harder to ignore the symptoms of tinnitus. 

If you’re hearing high-pitched humming, constant buzzing, or a loud roar that’s not coming from an external source, you may be ready to contact your doctor. Diagnostic exams may be able to pinpoint the cause of changes in your hearing, but will Medicare help cover the costs of audiologic diagnostic testing?

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Why You Might Need to Have a Hearing Test

If you’re experiencing a change in your hearing, you may be wondering if it’s time to see your doctor. Some people who notice a gradual decline in hearing may put off getting a hearing test until it’s affecting their quality of life, but it can be harder to ignore the symptoms of tinnitus. 

If you’re hearing high-pitched humming, constant buzzing, or a loud roar that’s not coming from an external source, you may be ready to contact your doctor. Diagnostic exams may be able to pinpoint the cause of changes in your hearing, but will Medicare help cover the costs of audiologic diagnostic testing?

Why You Might Need to Have a Hearing Test

Changes in your hearing can contribute to mental health issues and put your safety at risk, but they can also be symptoms of another condition. Early diagnosis and treatment for hearing issues can make a difference in your long-term quality of life.  

If you think you may have hearing loss but are not sure of the next steps, the National Institute on Deafness and Other Communication Disorders (NIDCD) suggests getting a hearing exam if you experience at least three of the following:

  • Embarrassment because you are struggling to hear someone you just met
  • Frustration talking to family members because you are having a hard time hearing them
  • Difficulty hearing or comprehending people at work
  • The sense of being limited by a hearing issue
  • Trouble hearing during visits to friends, family, or neighbors
  • Problems hearing when watching a movie at home or in a theater
  • Straining to hear the TV or radio
  • Arguments resulting from the inability to hear everything
  • Hearing limitation that impacts your social life
  • Filtering voices in a restaurant

Does Medicare Cover Hearing Tests and Hearing Aids?

  • Original Medicare does not cover the cost of routine hearing tests, exams for hearing aid fittings, or hearing aid devices
  • Medicare coverage is based on services and supplies that are medically necessary. Unfortunately, routine hearing exams are not included in Part A or Part B benefits. 
  • Medicare Part C, or Medicare Advantage, plans may include additional benefits, but costs and coverage can vary. 

When Does Medicare Cover Hearing Test Costs?

If your doctor orders an exam to diagnose a condition that may require medical treatment, Original Medicare covers the exams under Part B, the outpatient benefit. If the exam is covered, you pay 20% of the Medicare-approved amount after the Part B deductible is satisfied. If you have a Medigap (Medicare Supplement) plan, check to see your benefits for coinsurance coverage.

Your primary care doctor may refer you to a specialist, such as an otolaryngologist, which is an ear, nose and throat (ENT) specialist, or an audiologist. An audiologist is qualified to recognize, evaluate and manage hearing and balance disorders. 

If you have Original Medicare, you can visit any specialist that accepts assignment. If you’re enrolled in certain Medicare Advantage plans, like an HMO, you may need to get a referral from your primary care physician to see a specialist. 

Does Medicare Cover a Hearing Test for Tinnitus?

When you undergo an evaluation by a specialist, Medicare coverage is based on the reason for the diagnostic tests regardless of the final diagnosis. One of the reasons your doctor may order professional testing is that you’ve reported hearing sounds like ringing, whistling, hissing, buzzing, swishing, or clicking heard only by you. Hearing these types of sounds is a sign of tinnitus. According to the American Tinnitus Association (ATA), over 25 million adults nationwide have this condition, which is both audiological and neurological.  

TIP: Are you looking for a plan that offers more of what you need at a price that you can afford? Then check out our 7 reasons to switch Medicare Advantage plans guide.

Types and Causes of Tinnitus

There are two kinds of tinnitus: subjective and objective. Subjective tinnitus, the most common type, occurs when you hear noises unheard by others. Objective tinnitus, the second type, is a rare condition that is characterized by sounds emanating from your circulatory or musculoskeletal systems. These sounds may be audible by people aside from the patient.  

Tinnitus is a symptom of an underlying medical condition. You can link tinnitus to any one of hundreds of health disorders, but it often accompanies hearing loss. Once you reach 60 years of age, hearing can decline naturally, and tinnitus with age-related hearing loss is common. You may also experience tinnitus with hearing loss from noise exposure.

Depending on your symptoms, your doctor may suspect a different underlying cause for tinnitus, such as:

  • Blockages in the middle ear like wax or other obstructions
  • Trauma to the head and neck, including dental conditions
  • Temporomandibular joint (TMJ) disorder 
  • Nasal congestion or sinus pressure
  • Traumatic brain injury (TBI), often seen among military personnel
  • Side effects of specific medications

Based on your physician’s exam and preliminary diagnosis, you may be referred to an audiologist, otolaryngologist, psychologist, social worker, dentist, or physical therapist for further evaluation and/or treatment of the underlying condition.

Does Medicare Cover a Hearing Test for Balance?

Doctors not only order diagnostic hearing exams for patients with difficulty hearing and ringing in the ears but also for patients who complain of chronic dizziness. Feeling unsteady over a long period may indicate a balance disorder related to hearing loss. When your doctor orders a hearing exam to diagnose this condition, Medicare pays 80% of the Medicare-approved charges, and the Part B deductible applies. 

Balance issues and dizziness can lead to falls inside or outside of the home. According to the Centers for Disease Control and Prevention, approximately three million seniors are hospitalized for injuries due to falls each year. If you’re feeling off balance in conjunction with a change in your hearing, contact your doctor. 

Do Medicare Advantage Plans Include Hearing Services?

Medicare Advantage (MA) is another way to get your Original Medicare benefits along with extended coverage. Most MA plans include not only Part A and Part B but also prescription drug coverage, dental care and hearing services.

If you are enrolled in an MA plan, refer to the benefits described in your Evidence of Coverage. The plan may require that you arrange hearing services through a third-party partner, offering you a free exam and a discounted rate for hearing aids. Understanding your benefits is important, so you can take full advantage of your coverage and minimize out-of-pocket costs. 

TIP: Find out which Medicare Advantage plans offer coverage for hearing tests and hearing aids and compare them against your current Medicare benefits.

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