Vision and hearing coverage: what insurance pays for
Routine eye exams, glasses, contacts and hearing aids are often not covered by health insurance or Original Medicare. Here is what vision plans, hearing benefits and OTC hearing aids offer.
Health insurance and Original Medicare generally cover eye and ear problems that are medical, such as an eye injury, glaucoma treatment or a hearing exam your doctor orders to diagnose a problem. They usually do not cover routine eye exams for glasses, glasses and contacts, or hearing aids. A vision plan fills the first gap with a yearly exam and an allowance for lenses and frames. Hearing aids are harder: some Medicare Advantage plans and some supplemental policies include a hearing benefit, and since 2022 adults with perceived mild to moderate hearing loss can buy FDA-regulated hearing aids over the counter.
Medical versus routine: who pays for what
As my old site put it, most insurance companies focus on the reason for your visit. A routine exam that finds a problem can lead to a follow-up visit your health insurance covers.
| Service | Health insurance or Original Medicare | Vision or hearing plan |
|---|---|---|
| Eye injury, infection, glaucoma or cataract treatment | Usually yes, as medical care | No |
| Routine eye exam for glasses | Original Medicare: no. Many health plans: no for adults | Yes, typically once a year |
| Glasses or contacts | Original Medicare: generally no, except after cataract surgery with an implanted lens | Allowance on a set schedule |
| Diagnostic hearing exam ordered by a doctor | Usually yes | Sometimes |
| Hearing aids and fitting exams | Original Medicare: no | Sometimes, with an allowance or discount |
How vision plans work
If you or your family wear glasses or contacts and change prescriptions regularly, a vision plan often pays for itself. If you do not need corrective lenses, a periodic exam through your health plan or out of pocket may be enough.
- A yearly eye exam, often with a small copay.
- A materials allowance for lenses and frames or contacts, usually every 12 or 24 months.
- A network of optometrists and ophthalmologists; out-of-network care is reimbursed at a lower rate.
- Discounts on LASIK or PRK in many plans, rather than full coverage.
Hearing aids: your options
- Over-the-counter hearing aids. Since the FDA's 2022 rule, adults 18 and older with perceived mild to moderate hearing loss can buy them in stores and online without a prescription or exam.
- Prescription hearing aids through an audiologist, for moderate to severe or complex hearing loss, with professional fitting and follow-up.
- Medicare Advantage hearing benefits, which vary by plan in allowance, network and how often aids are replaced.
- Supplemental vision and hearing or dental, vision and hearing policies, which may include a hearing allowance or discount.
- Using HSA dollars, if you have an HSA, since hearing aids are a qualified medical expense.
Children
Pediatric vision is one of the ACA's essential health benefits, so ACA plans for children include eye care such as an exam and glasses on a set schedule. Check your plan's Summary of Benefits and Coverage for the details.
How pricing works
Vision and hearing premiums depend on the allowance amounts, how often materials are covered, the network and how many people are on the policy. Some plans bundle dental, vision and hearing together. Because prices vary by ZIP code and plan, I compare current options when you call rather than listing figures here.
Questions to ask
- Is my eye doctor or audiologist in network?
- How often are lenses, frames and contacts covered, and what is the allowance?
- Is there a hearing aid benefit, how much, and how often?
- If I am on Medicare, is this benefit already in my Medicare Advantage plan?
The bottom line
Routine eye care and hearing aids are two of the most common gaps people discover after they enroll in Medicare. If you wear glasses or are thinking about hearing aids, it is worth comparing a stand-alone plan against the extras in a Medicare Advantage plan. Send Lisa a message or call (303) 887-8584.
Want to go through this with someone?
Lisa Asmussen at our Brighton office will go through your doctors, your prescriptions and your real numbers, and explain plainly what we found. Take the Stress Out of Medicare
Sources
- Medicare.gov: Eye exams (routine), Medicare.gov (CMS)
- Medicare.gov: Hearing aids, Medicare.gov (CMS)
- FDA: OTC hearing aids, what you should know, fda.gov
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