Will Medicare pay for cochlear implants?

Under Medicare Part B, necessary and preventative services are covered. With cochlear implants falling under the medical equipment umbrella, it is more likely than not that the implants will be covered by Medicare.

Are you wondering “Does Medicare cover cochlear implant?”

Medicare does not cover the entire cost of the implants and surgery, but with the help of a Medicare Advantage plan, out-of-pocket costs can be covered. Depending on your needs, it may be a good idea to look into long-term care insurance as well.

Speak to your provider to check if Medicare does pay for cochlear implant. Find out if you meet the eligibility requirements for cochlear implants. Enter your ZIP code and get a free quote on Medicare insurance today.

What are the cochlear implant costs with Medicare?

Well, does Medicare really cover cochlear implants?

If you meet all eligibility criteria, and your care provider meets certain criteria, then Medicare will pay for up to 80% of the costs for cochlear implants and surgery.

If Medicare pays for 80% of the costs, then you are responsible for the other 20%. Cochlear implants are covered by most insurance companies because they are used to treat to severe-to-profound hearing loss.

Medicare Part B covers medically necessary and preventative services. This would include doctor visits, outpatient care, cancer screenings, medical equipment, and more.

Under Medicare Part B, cochlear implants are considered prosthetic devices.

A Medicare Advantage plan may help cover cochlear implants. This would vary per person, so speak to your provider. Prior authorization may be required. Medicare Advantage includes an annual out-of-pocket spending limit, which can cap what you spend on out-of-pocket Medicare costs each year.

How do I know if I am eligible for cochlear implant Medicare coverage?

Medicare isn’t always considered a traditional type of insurance; sometimes it is known as other insurance. There is a list of elibigility criteria that you must meet in order to receive Medicare coverage on your cochlear implants and surgery. The criteria are as follows:

1. You must be able to recognize sentences while wearing your hearing aids 40% of the time or less.
2. You must have a diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefits from hearing aids.
3. You should be able to use auditory clues and have a willingness to undergo a rehabilitation program.
4. You should have no medical problems that could put you at risk in surgery.
5. There should be no middle ear infection.
6. You must have an accessible cochlear lumen that can support the implantation.
7. You should have no lesions in the auditory nerve and acoustic areas of the central nervous system

If you meet all of the above criteria, then you should make sure that your care provider meets the eligibility requirements they need to in order for you to receive coverage.

Care Provider Eligibility

Care provider eligibility is not as complex as the criteria that each individual has to meet. There are three things that need to happen:

• The care provider should be in the FDA approved category B IDE clinical trial.
• The trial should be under the CMS Clinical Trial Policy.
• The trial must be a controlled comparative trial approved by CMS and consistent with evidentiary requirements for National Coverage Analyses meeting a specific quality of standards.

FDA-Approved Cochlear Implants

Care providers can find FDA-approved cochlear implants from three different companies.

1. Cochlear
2. Advanced Bionics Corp.
3. MED-EL Corp.

It is imperative to have FDA-approved cochlear implants to ensure that you are up-to-date with the implant technology. You can find providers directly through the Medicare website.

Get the breakdown of your cochlear implant costs, and see how Medicare will cover it for you. Enter your ZIP code to get free quotes on Medicare plans available near you.

Case Studies: Medicare Coverage for Cochlear Implants

Case Study 1: Sarah Johnson

Sarah Johnson, a 65-year-old retiree, had been experiencing profound hearing loss for several years. After exploring various options, she opted for a cochlear implant as recommended by her audiologist. Sarah was covered under Original Medicare, which consists of Part A (Hospital Insurance) and Part B (Medical Insurance).

Sarah’s case met Medicare’s criteria for cochlear implant coverage, as her hearing loss was considered severe enough to meet the Medicare guidelines. Additionally, she had documented attempts of using hearing aids without significant improvement. As a result, Medicare covered a substantial portion of Sarah’s cochlear implant surgery and related expenses.

Case Study 2: James Rodriguez

James Rodriguez, a 73-year-old Medicare beneficiary, had been struggling with hearing loss for many years. His audiologist suggested that a cochlear implant could greatly enhance his quality of life. However, James had a Medicare Advantage plan, which is an alternative to Original Medicare and offered by private insurance companies.

In James’s case, coverage for cochlear implants varied depending on his specific Medicare Advantage plan. Some plans may offer coverage for cochlear implants, while others may not. Therefore, James had to contact his Medicare Advantage plan directly to determine whether his surgery and associated costs would be covered.

Case Study 3: Emily Thompson

Emily Thompson, a 68-year-old Medicare beneficiary, was born with profound hearing loss. She had used hearing aids for most of her life, but they no longer provided sufficient benefit. Emily’s audiologist recommended a cochlear implant as the best course of action to improve her hearing.

As an individual covered under Original Medicare, Emily met the criteria for cochlear implant coverage. However, she had to go through the process of obtaining prior authorization from Medicare before proceeding with the surgery. After successfully obtaining the required authorization, Emily’s cochlear implant surgery and related costs were covered by Medicare.

Case Study 4: David Patel

David Patel, a 60-year-old Medicare beneficiary, experienced sudden hearing loss due to a medical condition. His audiologist suggested a cochlear implant as the most effective treatment option. However, David faced a unique challenge because his hearing loss was not a result of aging or congenital factors.

Since Medicare primarily covers hearing loss related to aging or congenital causes, David’s case did not meet the typical criteria for cochlear implant coverage. As a result, Medicare denied coverage for his cochlear implant surgery. David explored alternative funding options, such as private insurance or financial assistance programs, to cover the costs associated with the procedure.