Medicare Part B may help pay for cochlear implants under its prosthetics coverage, assuming you meet the other qualifications.
It’s estimated that nearly 9% for adults aged 55 to 64 have disabling hearing loss, and that rate increases to nearly 25% of those aged 65 to 74 and 50% to those 75 and older. In fact, one in three adults over age 65 has some kind of hearing loss in one or both ears, called age-related hearing loss (or presbycusis).
Some people have hearing loss and don’t even realize it, but hearing problems that are ignored or untreated can actually get worse. Hearing aids are a common treatment for those suffering from hearing loss, but another option for those with more severe or disabling hearing loss can be cochlear implants.
Read on to learn more about what a cochlear implant is, who may need one, what it does, and whether it is covered by Medicare.
What is a cochlear implant?
A cochlear implant is an electronic device that helps improve hearing for those with severe hearing loss from internal ear damage, or who are not able to hear well using hearing aids.
Cochlear implants bypass damaged portions of the ear to deliver sound signals directly to the auditory nerve. There are two types of implants, one with an external unit that attaches to the side of the head and combines the speech processor, microphone, and transmitter in one device, and one that has an external sound processor that fits behind the ear with a transmitter that attaches to the side of the head.
The processor captures sound signals and sends them to a receiver that’s implanted under the skin behind the ear, which then sends the signals to electrodes implanted in the inner ear (cochlea). Those signals stimulate the auditory nerve, which sends signals to the brain and interprets them as sound.
Implant devices may be placed in one or both ears, though adults will often start with one implant and one hearing aid first, then progress to two implants.
Because the sounds received aren’t like natural hearing, using a cochlear implant and learning to interpret the signals can take three to six months of use and rehabilitation. However, over time, those with these implants can make significant progress in understanding speech and other sounds.
Who needs a cochlear implant?
People who have severe hearing loss that is not helped by hearing aids may benefit from a cochlear implant. Typically, you must undergo specialized hearing tests that prove the limited benefit from hearing aids. You must also have hearing loss that interrupts spoken communication.
Adults of any age and children who are as young as six to 12 months old can benefit from cochlear implants.
What does a cochlear implant do?
A cochlear implant can do a number of things for patients. For example, many report having the ability to hear speech without needing visual cues, like reading lips. They may be able to better recognize everyday sounds, listen to someone or something in a noisy environment, or find where sounds are coming from. Hearing the TV, music, and phone conversations may be easier.
And, many report fewer or eliminated symptoms of ringing or buzzing in the ear with the implant.
Medicare coverage for cochlear implants
Generally, Medicare Part B covers costs associated with a prosthetic device needed to replace a body part or function, including a cochlear implant, when ordered by a provider enrolled in Medicare. Your implant must also be provided by a Medicare-enrolled prosthetic supplier that participates in Medicare and accepts assignment. (Learn more in our article, Does Medicare Cover Prosthetics?)
For coverage, individuals must meet all of these criteria: Have a diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with little benefit from hearing aids, the ability to use auditory clues and willingness to undergo an extended rehabilitation program after receiving the implant, and an accessible cochlear lumen that is suited to implantation. Patients cannot have a middle ear infection or any lesions, they must be a good overall candidate for surgery, and the device must be used in accordance with FDA-approved labeling.
Additionally, the individual must have a hearing test score between 40% and 60% when the provider is participating in, and patients are enrolled in, either an:
- FDA-approved category B investigational device exemption clinical trial
- A trial under the CMS Clinical Trial Policy
- A prospective, controlled comparative trail approved by CMS
Part B would also cover any medically necessary exams, imaging, or other services related to diagnosis and treatment. This may include visits to an audiologist.
Because surgery to place a cochlear implant is an outpatient procedure, the procedure and related services will also be covered by Part B.
If you aren’t sure whether your implant, surgery, or other services are covered, talk to your provider or contact Medicare directly.
How much does a cochlear implant cost?
The total cost of cochlear implants, including the devices, surgery, and rehabilitation, can cost between $30,000 and $50,000 or more.
However, if the implant and related services are covered by Medicare, you will typically only pay 20% coinsurance of the Medicare-approved amount (after meeting the Part B deductible, which is $226 in 2023). If you have Original Medicare plus a Medigap plan (Medicare Supplement Insurance), it should cover most of your coinsurance.
Your costs may be different if you have a Medicare Advantage plan (Part C), so check with your plan to learn what you may owe out-of-pocket. Unlike Original Medicare, Advantage plans have a yearly out-of-pocket max, so you may be pleasantly surprised. It’s easy to compare Medicare plan costs and benefits with our Find a Plan tool. Just enter your zip code to get started.
- ClearMatch Medicare: Find a Medicare Plan
- ClearMatch Medicare: How to Cope with Hearing Loss
- National Institute on Deafness and Other Communication Disorders: Quick Statistics About Hearing
- National Institute on Aging: Hearing Loss: A common Problem for Older Adults
- Centers for Medicare and Medicaid Services (CMS): Cochlear Implantation
- Medicare.gov: Contact Medicare