Insurance Resource Center

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Are Hearing Implants Covered by Insurance?

The good news is that unlike hearing aids, hearing implants may be covered by your insurance plan.* Also the evaluations are typically covered by insurance.

Please see the chart below for details.

A Step-By-Step Guide to the Insurance Process

Insurance Coverage for Hearing Aids vs. Hearing Implants

  Private Insurance Medicare Medicaid

Cochlear Nucleus® Hybrid Implant

May be covered*

May be covered

May be covered*

Cochlear Implants

Covered by most insurance plans*

Covered††

Typically covered**

Bone Conduction Implants

Covered by most insurance plans*

Covered††

Typically covered**

Hearing Aids

Typically not covered

By law are not covered

Typically covered**

*Contact your insurance company or local Hearing Implant Specialist to determine your eligibility for coverage.
**Coverage for adult Medicaid recipients varies according to state-specific guidelines.
†May be covered for patients that meet Medicare's current coverage criteria.
††Covered for Medicare beneficiaries who meet CMS criteria for coverage.

 

Frequently Asked Insurance Questions

You should be aware of your health plan coverage and the process of requesting and obtaining insurance approval for a hearing implant. We have information below that can help you find the answers you need to move forward in the treatment process.

An audiologist who is trained in cochlear implants and advanced hearing technology should perform a hearing evaluation. Other medical evaluations, X-rays or an MRI scan may be needed. It is important to find out if you are eligible for a hearing implant before obtaining insurance approval.

What costs are associated with a hearing implant?
Are hearing implants covered by insurance? (Medicare/Medicaid/Commercial/Tricare)

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The cost of hearing implants may be covered by your insurance plan. Every health insurance plan is different. Coverage varies by insurance company, plan benefits, the type of hearing implant you may need and your hearing loss. Potential out-of-pocket costs associated with receiving a hearing implant will include any coinsurance, copay and deductible according to your insurance plan. You should contact your insurance provider to determine coverage as well as estimated out-of-pocket expenses prior to surgery. Some services that you will want to discuss with your insurance provider are:

  • Hearing evaluation and test costs
  • Implant components costs (hearing implant and sound processor)
  • Implant procedure costs (hospital, physician, surgery, anesthesia)
  • Battery costs
  • Follow-up care
For private or commercial health insurance plans:
  • Most private insurance plans cover hearing implants.
  • Individual coverage, benefits and out-of-pocket costs will vary.
  • Please contact your insurance provider or clinic for more information.
For Medicare and Medicaid/CHIP plans:
  • Medicare covers hearing implants, both cochlear implants and bone conduction implants.
  • After completing your hearing evaluation, your audiologist will compare your results with the Medicare coverage criteria to determine your eligibility for coverage under Medicare.
  • Medicaid/CHIP covers hearing services for beneficiaries under age 21, and adults may be covered in some states.
  • Please contact your insurance provider or clinic for more information.
  • Download the Medicare Guide for more information.
For Tricare plans:
  • Tricare covers hearing implants, both cochlear implants and bone conduction implants.
  • Individual coverage, benefits and out-of-pocket costs will vary.
  • Please contact your insurance provider or clinic for more information.

 

What questions should I ask my health plan?

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Your coverage and out-of-pocket cost will be determined by your insurance provider and your specific plan benefits. Your insurance provider can give you details specific to your plan. You can contact them by calling the number listed on the back of your insurance member ID card. Download the worksheet below for additional questions and billing code information that you can provide to your insurance provider.
Some common questions you may want to ask your health plan include:

To see the full list of questions to ask your insurance provider, download the insurance worksheet.

 

What steps do I need to take to ensure my insurance will cover my hearing implant?

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Once it is determined that you are a candidate for a hearing implant, providers will begin to arrange for your surgery. This typically includes verifying your insurance benefits and obtaining any required authorization. Once authorization has been obtained, your provider or insurance company should notify you. You can also call your insurance provider to confirm you have authorization.
If it is necessary for you to obtain authorization, you should:

Cochlear's Pre-Surgical Insurance Support Team is available to help you obtain necessary insurance approval and provide assistance in appealing denied coverage for Cochlear's Nucleus and Baha Systems. For pre-surgical insurance questions, please contact:
Insurance Support Team
Phone: (800) 633-4667 (Option 4)
Email: OMS@Cochlear.com

 

What if I need help obtaining insurance approval?

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To make the process easier, Cochlear's Pre-Surgical Insurance Support Team is available to help you obtain necessary insurance approval and provide assistance in appealing denied coverage for Cochlear's Nucleus and Baha Systems.
For pre-surgical insurance questions, please contact:
Insurance Support Team
Phone: (800) 633-4667 (Option 4)
Email: OMS@Cochlear.com

What if my insurance plan denies my request for coverage?

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Review the written response provided by the health plan and consider appealing the denial if:

Contact our Insurance Support Department for assistance with the appeal process.
Insurance Support Team
Phone: (800) 633-4667 (Option 4)
Email: OMS@Cochlear.com

 

What options do I have for funding if I have been denied coverage for my hearing implant?

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Occasionally, health plans do not provide coverage for hearing implant solutions. Cochlear has compiled a list of established funding sources for Cochlear Implants and Baha Systems. Other sources of funding or small local programs may be available in your area. We recommend you to contact your audiologist or hearing health specialist to find out information regarding current federal and state programs and resources that may be available in your community.
Some options to explore include:

  • Employer-Sponsored Health Plans: Check to see if your employer offers other health insurance plans and if those plans provide you with coverage for your hearing implant. It may be possible to switch during your open enrollment period.
  • State Health Insurance Marketplace: Research and explore the option of purchasing an individual plan that may provide you with hearing implant coverage.
  • Medicaid Coverage: Coverage for hearing implants vary by state and eligibility is subject to change. Some states have expanded eligibility under the Patient Protection and Affordable Care Act. Contact your hearing implant specialist or your state Medicaid program for more details.
  • Colorado Neurologic Institute (CNI): The CNI offers Cochlear Implant and Baha System Assistance Programs. Assistance is offered to candidates who have no other means of paying for a cochlear implant or bone conduction implant. For additional information or a program application, visit: www.thecni.org.
Ask your insurance provider if your Heath Savings Account (HSA) or Flexible Spending Account (FSA) can provide you with financial support for your hearing implant.
To see the full list of funding options, download our Alternative Funding Worksheet.

 

 

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