Medicare, Medicare Advantage hearing benefits, and what your pages may say.

What Medicare covers

Medicare.gov says it in one sentence: "Medicare doesn't cover hearing aids or exams for fitting hearing aids." Original Medicare Part B does cover diagnostic hearing and balance exams when a doctor or other provider orders them to decide whether medical treatment is needed, at 20% coinsurance after the Part B deductible. So a clinic page that says "free hearing test with Medicare" is wrong twice: the fitting exam is not covered at all, and the diagnostic exam carries coinsurance.

The clinic's own audiologist can usually say all this in a sentence; the website often says something else, because it was written to sell. Start by making the Medicare sentence true.

The direct-access visit and the AB modifier

Since January 1, 2023, a Medicare beneficiary can see an audiologist once every 12 months without a physician's order for non-acute hearing conditions, such as gradual age-related loss, and for diagnostic tests related to implanted devices. CMS's transmittal sets out the mechanics: the audiologist appends the AB modifier to one of 36 CPT codes (two more, 92622 and 92623, were added on January 1, 2024), the policy is limited to "once every 12-months, per beneficiary", and it "may not include audiology services that are related to disequilibrium, or hearing aids" or exams to prescribe, fit or change hearing aids. ASHA's summary adds that hearing and balance tests cannot be combined under it and calls the limits "arbitrary", which most audiologists would agree with.

What a page can say: "If you have Medicare, you can book a hearing evaluation with our audiologist once every 12 months without a referral from your doctor. The visit is for non-acute hearing conditions such as gradual hearing loss. It does not include hearing aid fitting, and Medicare does not cover hearing aids. Part B coinsurance applies." Four sentences, each one true. What a page cannot say: "Medicare covers your hearing test", "no referral needed for any visit", or anything about hearing aids being covered. The provider approves the paragraph; the billing manager reads it too.

Medicare Advantage in 2026

KFF's first look at 2026 plans, published December 9, 2025, found that 98% of individual Medicare Advantage plans offer some hearing benefit (exams, aids or both), as 97% or more did in 2025 for vision, dental or hearing. More than 34 million people, 54% of eligible beneficiaries, were enrolled in Medicare Advantage in 2025. The scope of the benefit varies by plan and plans can change the terms every year, so a clinic page that quotes a plan's allowance for hearing aids is wrong by the following January.

Outside Medicare, coverage is thin: HearingTracker's 2024 review counted fewer than 10 states that require insurers to offer any adult hearing aid coverage, and about 32 state Medicaid programs that cover adult hearing. MarkeTrak 2022 found 54% of owners had some third-party help paying, and that even with full coverage 19% of non-owners would still not buy. If your state's Medicaid program covers adult hearing aids and the clinic accepts it, that belongs on the same page as the Medicare paragraph, in one plain sentence with the date it was checked, because "audiologist that takes medicaid [town]" is a search with almost no local answers.

The benefit managers

Many Medicare Advantage hearing benefits may be managed by a hearing benefit manager, a third party that holds the provider network, sets the allowances and tells the member where to go. The Capitol Forum reported in June 2026 that four of the five big hearing aid manufacturers run such managers, and that the fifth sold its manager to a large insurer in 2018. The practical effect for an independent clinic is that a plan member calling the number on their card may be routed to a network provider that is, in effect, a manufacturer's own outlet, and that the member's allowance may apply only to devices the manager supplies.

A clinic can join networks, decline them, or join some; that is a business decision outside this guide. What the website can do is make the clinic's position plain, so a member does not drive across town and find out at the front desk.

The searches members make

The searches are not "audiologist [town]". They are "does medicare cover hearing aids", "hearing aids covered by [plan name] [town]", "[plan name] hearing benefit audiologist near me", "medicare hearing test no referral", and "how much does medicare pay for hearing aids". The first and last are informational and in Whitespark's May 2025 study that kind of search drew an AI Overview 92% of the time; a clinic page will be read, cited and summarized more than it is clicked. The middle three are local and specific, and a clinic that works with the plan and says so on a page will often be the only local page that matches.

The page to write, and the wording

One page, "Medicare, Medicare Advantage and insurance at [clinic name]", 600 to 900 words, approved by the provider and read by whoever does the billing. The sections, with wording that stays inside the rules:

1. Original Medicare. The four sentences above. Add the coinsurance line and the fact that the clinic bills Part B for diagnostic visits if it does.
2. Medicare Advantage plans we work with. A list of the plans and benefit networks the clinic is in, by name, with the date the list was checked. Plans change networks; a page dated "checked October 2026" is honest, and a page with no date becomes false silently.
3. Plans we are not in. The sentence that is easy to leave off: "If your plan's hearing benefit uses a network we are not part of, you can still see us, and your plan may have an out-of-network option; call the number on your card and ask about hearing benefits outside the network." No promise that it will be covered.
4. What the benefit usually covers and what it does not. In general terms only: an allowance toward devices from the network's list, sometimes an exam, usually with a copay; follow-up care and repairs vary. Never a dollar figure for a named plan.
5. How to check your own benefit. The three questions to ask the plan: which providers are in the hearing network, what the allowance is and which devices it applies to, and whether follow-up visits are included.
6. What to bring. The card, the list of medications, and the earbud test result if they have one.

Two rules on the wording. First, no coverage promises: every sentence about a plan is about what the plan generally does, and the plan decides. Second, the state advertising rules still apply: Texas 402.103(c) treats a misstatement of fact as deceptive advertising; Florida rule 64B6-7.005 bars communications "likely to create an unjustified expectation about results". "Medicare covers it" is both.

Five sentences we find on clinic websites, and what to write instead

"Free hearing test with Medicare." Medicare does not cover the fitting exam, and the diagnostic exam carries Part B coinsurance. Write: "If you have Medicare, a diagnostic hearing evaluation may be covered under Part B when it is medically necessary; coinsurance and the deductible apply. Hearing aid fitting exams are not covered."

"No referral needed." True only for the once-per-12-months direct-access visit for non-acute conditions, and not for anything to do with hearing aids. Write the four-sentence paragraph above, with the limits in it.

"We accept all Medicare Advantage plans." Accepting a plan and being in its hearing benefit network are different things, and the network decides the allowance. Write the dated list of networks you are in and the out-of-network sentence.

"Your plan pays up to $2,500 toward hearing aids." Even if it was true in January, plans change benefits every year and the number belongs to the plan. Write: "Many plans provide an allowance toward hearing aids through a benefit network; the amount and the devices it applies to are set by your plan. We will help you check before your appointment."

"Medicare-approved hearing aids." There is no such thing. Delete it.

The front-desk script that matches the page

The website promise is only as good as the answer the desk gives when the phone rings. For a Medicare caller: ask whether they have Original Medicare or a Medicare Advantage plan; if Original, offer the direct-access evaluation and say that coinsurance applies; if Advantage, ask for the plan name, check your dated list, and if the plan uses a network you are not in, say so and give them the three questions to ask the plan. Write the script down, keep it next to the dated list, and update both together each November when the plans publish next year's benefits.

For a caller who was told by the plan to go to a network provider across town: do not disparage the provider or the plan. Tell them what you offer, what a visit costs without the benefit, and that the choice is theirs. The page and the script should agree, because the caller has often read the page first.

The HIPAA line on marketing to patients

The annual enrollment period, October 15 to December 7, tempts clinics to email their patient list about hearing benefits. Read 45 CFR 164.508(a)(3) first: a covered entity needs a patient's written authorization for any use of protected health information for marketing, with two exceptions, a face-to-face communication and a promotional gift of nominal value, and HHS's guidance says marketing is a communication that "encourages recipients of the communication to purchase or use the product or service". HHS treats a provider's own description of its services and treatment communications differently from marketing, but the line is thin and the penalties are real. A page on the public website that any member can read raises none of this. A mailing to the patient list about "upgrade your hearing aids with your 2027 benefit" may. Ask whoever handles your compliance before sending it, and do not ask us to send it, because we will not.

What to do in the next hour

1. Find every sentence on your site that contains "Medicare". Check each against the Medicare.gov line above.
2. List the hearing benefit networks you are in, with today's date.
3. Draft the four-sentence direct-access paragraph and send it to the provider and the billing manager.