Medicaid covers hearing aids in most states, but the details vary widely by state and age
Medicaid does cover hearing aids in 48 states and Washington D.C., but what that coverage actually means depends on where you live and how old you are. Some states cover the full cost of hearing aids and the exam to fit them. Others cover only the exam, or only one hearing aid per ear per year, or only for children. A few states cover nothing at all. Your state Medicaid program sets its own rules, so you need to check with your specific state to know what you will actually receive.
The fastest way to find out what your state covers is to call your state Medicaid office directly or visit its website. You can also call your local Medicaid managed care plan if you are enrolled in one — they often have different rules than the state program. If you are over 65, Medicare may cover a hearing aid exam but not the aids themselves, which is a separate issue from Medicaid.
Key Takeaways
- Medicaid hearing aid coverage exists in 48 states, but the scope ranges from full coverage to no coverage depending on your state.
- Most states that cover hearing aids limit you to one pair per ear per year or per two years, and some states cover only children or only adults over a certain age.
- You will need a prescription or referral from a doctor or audiologist before Medicaid will pay, and you must use a provider on your state's approved list.
- Your state Medicaid office or your managed care plan can tell you in one phone call whether hearing aids are covered, what the limits are, and which providers you can use.
Which states cover hearing aids and what the limits are
Coverage breaks down into three groups: states with broad coverage, states with limited coverage, and states with no coverage. The broad-coverage states typically pay for the hearing aids themselves, the audiologist exam, and the fitting. Limited-coverage states might pay for the exam only, or for one hearing aid per ear per year, or only for children under 18. Two states — Connecticut and New Hampshire — do not cover hearing aids through Medicaid at all.
Even within broad-coverage states, there are caps. Some states will pay up to $1,000 per hearing aid, others up to $3,000. Some require you to try a less expensive model first before approving a more advanced one. Some cover only behind-the-ear or in-the-ear styles and not custom-molded aids. The only way to know your state's exact limits is to contact your state Medicaid program or your managed care plan.
If you are enrolled in Medicaid managed care (a private insurance plan that Medicaid pays to cover you), your plan may have different rules than the state program. Call the customer service number on your Medicaid card to ask what hearing aid coverage your specific plan offers.
How to get a hearing aid through Medicaid
The process starts with a referral or prescription from your primary care doctor or from an audiologist. Medicaid will not pay for a hearing aid without this documentation. Your doctor or audiologist will need to document that you have hearing loss and that a hearing aid is medically necessary.
Next, you must use a provider — an audiologist or hearing aid dispenser — who is on your state Medicaid program's approved list. If you go to an out-of-network provider, Medicaid will not pay. Your state Medicaid office or managed care plan can give you the list of approved providers in your area. Call ahead to confirm they accept your Medicaid plan and that they have the type of hearing aid you need in stock.
Once you have chosen a provider and have your referral, the provider will submit the claim to Medicaid on your behalf. Approval usually takes one to three weeks. Some states require prior authorization — meaning the provider must get approval from Medicaid before fitting the hearing aid. Others approve the claim after the fact. Ask your provider which process applies in your state.
What you may have to pay out of pocket
Even when Medicaid covers hearing aids, you may owe a copay or coinsurance. The amount varies by state and by your Medicaid plan. Some states charge a flat copay of $5 to $25 per hearing aid. Others charge a percentage of the cost. Some states charge nothing at all.
If the hearing aid costs more than what Medicaid will pay, you are responsible for the difference. For example, if Medicaid covers up to $2,000 per hearing aid and the aid you want costs $3,500, you would owe $1,500 plus any copay. Some providers offer payment plans for the amount you owe out of pocket.
If you cannot afford the out-of-pocket cost, ask your provider about manufacturer assistance programs. Many hearing aid manufacturers offer discounts or free or reduced-cost aids to people with low income. These programs are separate from Medicaid and do not require a Medicaid claim.
Coverage for children versus adults
Some states cover hearing aids for children but not for adults, or cover them more generously for children. This is because federal Medicaid rules require states to cover hearing aids for children as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program. EPSDT is a benefit for people under 21 that covers a broader range of services than adult Medicaid does.
If you have a child on Medicaid, hearing aids are more likely to be covered than if you are an adult. However, the state still sets limits — some states cover one pair per ear per year for children, others cover two pairs per year. Call your state Medicaid program to ask what the limits are for children.
If you are an adult and your state does not cover hearing aids, you may still be able to get help through a nonprofit organization, a community health center, or a state vocational rehabilitation program if you are working or trying to work.
What happens if your state does not cover hearing aids
If you live in Connecticut, New Hampshire, or another state with no Medicaid hearing aid coverage, you have other options. Community health centers often provide hearing exams and can refer you to low-cost hearing aid programs. Some centers offer hearing aids on a sliding fee scale based on your income.
State vocational rehabilitation agencies may cover hearing aids if you are working or preparing for work and the hearing loss affects your job. You can find your state's vocational rehabilitation office through the Rehabilitation Research and Training Center website.
Nonprofit organizations like the Hearing Loss Association of America and the American Speech-Language-Hearing Association maintain lists of programs that offer reduced-cost or free hearing aids. Some manufacturers also run patient assistance programs that provide aids at no cost or reduced cost to people with low income, regardless of Medicaid status.
Medicare versus Medicaid for hearing aids
If you are 65 or older and on Medicare, Medicare does not cover hearing aids or hearing aid exams. Medicare covers a hearing test only if your doctor orders it for a specific medical reason, such as to check for balance problems. This is different from Medicaid, which may cover the full cost of hearing aids and the fitting exam.
If you are on both Medicare and Medicaid (called "dual may be able to access"), your Medicaid program may still cover hearing aids, depending on your state. Call your state Medicaid office to ask. Do not assume that because Medicare does not cover hearing aids, Medicaid will not either — they are separate programs with separate rules.
Frequently Asked Questions
Do I need a hearing test before Medicaid will pay for a hearing aid?
Yes. You need a referral or prescription from a doctor or audiologist that documents your hearing loss and states that a hearing aid is medically necessary. Some states cover the hearing test itself through Medicaid; others do not. Ask your state Medicaid program whether the test is covered before you schedule one.
Can I choose any hearing aid I want, or does Medicaid limit the type?
Most states limit the type and price. Some cover only behind-the-ear aids, not custom-molded or invisible aids. Some have a maximum price per aid, such as $2,000 or $3,000. Your state Medicaid program or your provider can tell you which models and brands are covered under your plan.
What if I need a new hearing aid before my state's coverage period is up?
Most states cover one pair of hearing aids per ear per year or per two years. If your hearing aid breaks or stops working before that period ends, call your state Medicaid program to ask about a replacement. Some states will replace a broken aid outside the normal coverage window; others will not.
Can I use a hearing aid I bought myself and then ask Medicaid to reimburse me?
No. Medicaid will not reimburse you for a hearing aid you bought on your own. You must have Medicaid approval and use an approved provider before you purchase the aid. If you buy first and ask for reimbursement later, Medicaid will deny the claim.
What if my Medicaid managed care plan denies my hearing aid claim?
You have the right to appeal. Ask your plan for a copy of the denial letter, which will explain the reason. Common reasons are that the provider is out of network, that you do not have a valid referral, or that you have already used your annual coverage. You can file an appeal with your plan within 60 days of the denial. If the plan denies your appeal, you can request an independent review.