Does Medicare Cover Cochlear Implants?
Medicare will pay 80 percent of the cost for cochlear implants and surgery for those who qualify. Eligibility is based on several factors, including the severity of your hearing loss. You may need to participate in a clinical trial to receive Medicare coverage for your cochlear implants.
Understanding Medicare Coverage of Cochlear Implants
Medicare and other federal health programs provide at least some coverage for cochlear implants.
Cochlear implants are not hearing aids. Original Medicare does not cover hearing aids.
Coverage for Beneficiaries with Hearing of 40 Percent or Less
Generally, a cochlear implant is covered by Medicare if you recognize sentences while wearing your hearing aids only 40 percent of the time or less.
- You’ve received a diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from hearing aids.
- You are able to use auditory clues and have a willingness to undergo a rehabilitation program.
- You have no medical problems that could put you at risk during surgery.
- You have no middle ear infection.
- You have an accessible cochlear lumen that can support an implantation.
- You have no lesions in the auditory nerve and acoustic areas of the central nervous system.
Three companies manufacture FDA-approved cochlear implant devices: Cochlear, Advanced Bionics Corp. and MED-EL Corp.
Medicare Coverage for Beneficiaries with Hearing of 41 to 60 Percent
If you score between 41 and 60 percent on a hearing test, you may be eligible for Medicare coverage only if your provider is participating in an approved cochlear implant clinical trial.
- An FDA-approved category B IDE clinical trial
- A trial under the CMS Clinical Trial Policy
- A controlled comparative trial approved by CMS and consistent with the evidentiary requirements for National Coverage Analyses that meets specific quality standards
Cochlear Implants Costs
If you meet Medicare’s criteria for cochlear implants, you may still owe some money out-of-pocket.
You will likely owe 20 percent for the Medicare-approved cost of the device, and the Part B deductible applies.
You may owe less if you have supplement insurance, such as Medicaid or a Medigap policy.
Medicare Advantage plans must offer the same basic benefits as Original Medicare (Part A and Part B), but many offer additional benefits.
If you’re enrolled in a Medicare Advantage plan, check with your plan provider to learn more about its coverage of cochlear implants. Prior authorization may be required.
Most surgeons who perform cochlear implants have insurance experts on staff who can help you navigate your plan’s rules and answer questions.
Cochlear implant monitoring — including remapping and reprogramming — as well as rehabilitation following your surgery is usually covered as an outpatient rehabilitation therapy benefit.
Check your specific plan or ask an insurance expert at your surgeon’s office for more information about any out-of-pocket costs for follow-up care and rehabilitation.
What Are Cochlear Implants?
Cochlear implants are small devices surgically implanted inside your ear to stimulate the auditory nerve with electrical currents.
They bypass hair cells inside the ear and directly transmit sounds through multiple electrodes.
The purpose of implanting the device is to provide awareness and identification of sounds for people who are moderately to profoundly hearing impaired.
- A microphone, which picks up sounds, worn externally behind the ear
- An external speech processor, which converts sounds to electrical signals
- A transmitter and receiver/stimulator, which relay the signals.
- Implanted electrodes, which stimulate the fibers of the auditory nerve
Cochlear implants are available in single-channel and multi-channel models.
According to the Centers for Medicare and Medicaid Services, you will need to return to the implanting center four to five weeks after post-surgery healing to get your speech processor programmed.
The number of visits needed to properly optimize your device depends on several factors, including your age and cognitive skills.
Because your response to nerve stimulation may change, you’ll need long-term follow-up after your procedure.
6 Cited Research Articles
- United Healthcare. (2020, September 9). Cochlear Implantation (NCD 50.3). Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-guidelines/c/cochlear-implantation.pdf
- Buchman, C.A. et al. (2020, August 27). Unilateral Cochlear Implants for Severe, Profound, or Moderate Sloping to Profound Bilateral Sensorineural Hearing Loss: A Systematic Review and Consensus Statements. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32857157/
- American Cochlear Implant Alliance. (2020). Cochlear Implants (CI), Hearing Aids, and Older Adults. Retrieved from https://cdn.ymaws.com/www.acialliance.org/resource/resmgr/advocacy/cochlear_implants_fact.sheet.pdf
- American Cochlear Implant Alliance. (2018, February 23). Continuation of Medicare Expansion Study. Retrieved from https://www.acialliance.org/page/MedicareExpansion
- Centers for Medicare & Medicaid Services. (n.d.). Cochlear Implantation. Retrieved from https://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/Cochlear-Implantation-
- Medicare.gov. (n.d.). Prosthetic devices. Retrieved from https://www.medicare.gov/coverage/prosthetic-devices