Does Medicare Cover Cochlear Implants? 5 Quick Facts.

Have you wanted to know if Medicare covers cochlear implants?

This article is a quick guide to what cochlear implants are, whether Medicare covers them, the eligibility criteria for Medicare cochlear implants, and how much is covered.

What are Cochlear Implants?

Cochlear implants are surgically implanted small electronic medical devices to help give sound signals to the brain for a person with a damaged inner ear, serious hearing problems, or who is deaf. A cochlear implant includes a microphone, a speech processor, a transmitter and simulator, and an electrode array.

Both young children and adults can use cochlear implants. Research has shown that one-third of 65 years old and above suffer from hearing loss. This problem could lead to depression, depletion in physical health, isolation, and sudden death.

Even though a cochlear implant doesn't restore normal hearing to the deaf, it can aid the understanding of sounds in the environment and speech.

Who is Eligible for Medicare Cochlear Implants?

To be eligible for Cochlear implants, you must suffer from a severe hearing problem in one or both of your ears.
You must be registered on Medicare.
Cochlear implants must be recommended by your doctor, who is also enrolled in Medicare.
You have no medical issues that could put you in danger during surgery.
You have no middle ear infection.

Which Medicare Part Covers Medicare Cochlear Implant?

Medicare Part B, a part of the original Medicare, covers cochlear implants and the accessories like microphones and batteries when your doctor recommends it. Likewise, Medicare Part C, a Medicare Advantage Plan, covers cochlear implants and many other benefits that Medicare Part B does not cover.

These benefits include out-of-pocket spending limits each year, which reduces the amount you spend on Medicare costs annually. Medicare Part A and B do not offer this.

Why Does Medicare Cover Cochlear Implants?

That's simple. Medicare covers cochlear implants because they are a standard treatment for severe nerve deafness. Medicare has been covering for cochlear implants since 2004, and several health insurance companies also cover cochlear implants.

How Much Does Medicare Cover?

Without health Insurance coverage such as Medicare, Cochlear implants cost $30,000 to $50,000 on average.

However, Medicare reduces the cost of cochlear implants by 75 to 80 percent. Therefore, the cost is further reduced if you have supplement insurance, such as Medicaid or a Medigap policy.

It is worth noting that there may be some out-of-pocket expenses you need to make which are not included in what Medicare covers.

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Conclusion:

The cost of a Cochlear implant and how much Medicare covers also varies based on factors such as your doctor's charges, the cost of purchasing the device and where you bought it, facilities used, etc.

Frequently Asked Questions

How much will everything cost?

In the U.S. and Canada, the costs of cochlear implants can vary per region, but in general, can cost anywhere from $60,000 to $100,000 when you add up the total cost of the consultations, surgery, the device, the surgeon's fee, and post-operative audiology visits.

Will my health insurance plan pay for a cochlear implant?

If you have Medicare, Medicaid, or VA benefits, and some other public health plans, cochlear implant surgery is covered. If you have private insurance, you'll have to get a pre-authorization before getting surgery. Since treating severe or profound hearing impairment is medically necessary, the surgery is covered by most U.S. insurers.

My health insurance plan has denied coverage for a cochlear implant. How can I appeal?

You should first determine why you were denied. Did you get this in writing? If not, request that they send the reason in writing. Then you can properly structure a response based on their denial reason, if they do not specify a reason, try contacting the cochlear implant manufacturer, the cochlear implant center and other advocacy groups for help.

Will Medicare pay for cochlear implantation?

Yes, Medicare covers a portion of the costs of cochlear implant surgery if you meet the requirements. Medicare will also cover services necessary to maintain the function of the cochlear implant. Keep in mind that Medicare covers many services, the payment is low and it can be challenging working with the administration.

Will any parts of my implant system ever require maintenance?

The implants are designed to last a lifetime, of course, there is a possibility of malfunction, if you play contact sports or bicycle, you could consider wearing helmets or protective headgear to minimize the possibility of damage. If your implant does become non-functional, getting reimplanted isn't a big deal. The components are durable, but you should expect to replace the batteries, cables, or microphones over time.

Will my insurance plan pay for repairs or replacement parts for my sound or speech processor?

While you should first read your plan benefits booklet to confirm this, many health plans do not include specific benefits to cover repairs or replacements, but if your policy includes durable medical equipment (DME) benefits, that can be applied.

Will Medicaid cover parts and accessories?

The first thing you should do is contact your local Medicaid office to ask about coverage. Most state Medicaid agencies cover cochlear implants, but like Medicare, it has covered the necessary parts and accessories needed by the Medicaid recipient in the past.