Does Medicare Cover Cochlear Implants?

Cochlear implants have become a standard treatment for people who have severe to profound nerve deafness, letting them hear a functional representation of the sounds and voices around them. Although these surgically implanted devices can be costly, most insurance carriers consider them medically necessary for many individuals and cover at least a portion of the expense. In this article, you’ll learn what a cochlear implant does and explore the options for reimbursement through Medicare, Medicaid and other insurance plans.

What Is a Cochlear Implant?

A cochlear implant is a small, two-part electronic device designed to provide the sense of sound to a hearing-impaired or deaf individual. The implant includes a receiving component, which is surgically placed beneath the skin, and a corresponding external transmitter that sits just behind the ear.

Once it's been surgically implanted, a cochlear implant can bypass damaged parts of the user’s ear to deliver a signal directly to the auditory nerve. These device-generated signals are then sent by the auditory nerve to the brain, which recognizes them as sound. These units let many hearing-impaired or deaf individuals understand sounds, including warning signals and speech, even over the telephone. Users must participate in long-term therapeutic training to be able to effectively use these implants.

Do Cochlear Implants Restore Normal Hearing?

No. Cochlear implants can’t restore normal hearing for hearing-impaired or deaf individuals. Instead, they provide a functional representation of environmental sounds and can help the recipient understand speech. Because the sound a user hears is different from the one heard naturally, it may take time and therapeutic training for a recipient to understand and interpret what they’re actually hearing.

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What Is the Cost of a Cochlear Implant?

Without insurance coverage, the cost of cochlear implants typically ranges between $30,000 and $50,000. Although the expense may be prohibitive, most insurance policies cover the device, surgical implantation and therapy required to train the brain to use it. Organizations such as Help America Hear may also be able to provide financial counseling for families who need help paying for a device.

Does Medicare Cover Cochlear Implants?

Yes. As long as a Medicare-approved physician deems cochlear implants medically necessary for a beneficiary, these devices are now considered standard treatment for severe to profound nerve deafness and are included on Medicare’s list of covered prosthetic devices. The units must be furnished by a Medicare-approved prosthetic supplier, and either you or the supplier may submit the claim.

Because they’re surgically implanted, cochlear implants may be covered under Medicare Part A or Part B depending on whether the surgery is performed on an inpatient or outpatient basis. If Part B is providing coverage, beneficiaries must first meet the deductible and then are expected to pay 20% of the Medicare-approved cost for the device.

Costs may vary based on the following factors:

• Additional insurance coverage held by the beneficiary
• The facility type
• Your doctor’s fees
• Whether your doctor accepts Medicare assignments
• Where you get your device and service

Medicare typically also covers services, including therapy, that are deemed necessary for cochlear implants to function properly.

Do Medicare Advantage Plans Cover Cochlear Implants?

Yes. Although Medicare Advantage plans vary by carrier and region, all policies must cover, at minimum, the same services covered by original Medicare. This currently includes cochlear implants, if they are deemed medically necessary by your physician. Certain MA plans may require the beneficiary to have the implantation performed by an in-network surgeon at a covered facility.

With Medicare Advantage, the cost of your implants may vary depending on your policy’s co-pay or coinsurance amount. But, because MA plans cap annual out-of-pocket spending, they may reduce the amount you’ll need to lay out for the implant.

Does Medicaid Cover Cochlear Implants?

Yes. Although Medicaid programs vary by state, most plans currently cover cochlear implants and the surgery required to insert them. Depending on your plan, Medicaid may also cover the cost accessories, such as water-safe sound processors. Check with your state’s Medicaid office for the specifics of your policy.

How Much Does a Cochlear Implant Cost With Commercial Insurance?

Most insurance companies now recognize cochlear implants as a standard treatment for nerve deafness, and will cover at least a portion of the surgery and subsequent therapy involved in training the brain to work with the device. Coverage varies depending on the insurance company and specific plan, and the implant center generally takes responsibility for securing any necessary preauthorization.

A plan representative at your insurance company should be able to help you understand the covered benefits and reimbursement requirements for your specific policy to make sure you receive the maximum coverage available.

Where Can I Get More Information About Cochlear Implants?

Choosing whether to have cochlear implant surgery is a major decision, and most device manufacturers sponsor forums where you can connect with implant recipients and their families. If you still want to know more about cochlear implants, the National Institute on Deafness and Other Communication Disorders maintains a searchable directory of organizations that can provide information and answer questions about hearing disorders and available treatments. Your physician or audiologist can also point you in the direction of additional resources.