Numerous people over the age of 65 experience severe hearing loss that diminishes their ability to interpret normal speech. Although hearing aids do benefit many people who use them, others receive no significant hearing benefits. Cochlear implants offer an alternative to help restore hearing. Does Medicare cover Cochlear implants, and if so, what are the requirements for candidacy?
Candidacy for a cochlear implant involves an individual’s hearing ability and their projected outcomes with a cochlear implant. A comprehensive assessment is necessary. Hearing healthcare professionals have extensive experience in evaluating persons for cochlear implants. The evaluation process includes an evaluation of the candidate’s speech, language, and auditory skills, medical evaluation, balance assessment, and device orientation. Some specific requirements include:
There are several costs involved, including the implant and processor, the surgery, hospital costs, and audiology services. The implant and the processor typically cost up to $30,000. Cochlear implants are under the statutory Medicare benefit provision for prosthetic devices. Medicare has a policy of providing coverage for cochlear implants when the patient meets the coverage criteria. It is essential to discuss the costs of an implant with your insurance provider regarding your coverage. There are many costs, including hearing evaluation and tests, implant components, implant procedures, batteries, follow-up visits, and rehabilitation.
Before you can opt for a surgical approach to treat your hearing loss, a hearing healthcare provider will assess your specific hearing needs. After determining the nature of your hearing loss, and if you will not benefit from a hearing aid, a Cochlear implant may be part of the discussion. Your hearing loss must be severe enough to hinder your understanding of spoken words. Not like a hearing aid that amplifies sound, a Cochlear implant takes a different route that avoids the damaged parts of your ear. The device converts sound to electrical signals which stimulate the auditory nerves. Upon completion of the procedure, you will participate in a rehabilitation process that will instruct you in interpreting the signals you receive from the implants.
Medicare Part B covers approved surgically implanted devices such as cochlear implants and bone conduction implants. Medicare regulations allow hearing healthcare professionals reimbursement for diagnostic procedures involving the initial and subsequent programming of cochlear implants. A Medicare-enrolled prosthetic supplier who is participating in Medicare must provide the implant. After the completion of a hearing evaluation, a hearing healthcare professional will compare your outcomes with the Medicare coverage criteria to decide your eligibility for coverage under Medicare. If accepted for candidacy, you will pay 20% of the costs of your cochlear implant, and your deductible will apply.
There is a disparity between Medicare Cochlear implant candidacy and non-Medicare patient candidacy. Many people who would benefit from a Cochlear implant do not meet the Medicare coverage guidelines. Hopefully, an expansion of the Medicare candidacy will eliminate this disparity that currently exists.