Insurance conversations tend to fall into the same category as assembling furniture or doing taxes, no one wants to do it, but we all have to. And when it comes to hearing care, things can get especially confusing. You might ask two representatives the same question and end up with two completely different answers. Frustrating? Absolutely. But that’s exactly why this part of our patient education series exists: to help clear up the most common insurance questions we hear every day.

What Does Insurance Cover for a Basic Appointment?

Let’s start with the basics.

For a standard hearing evaluation, some insurance plans do cover the main portion of the hearing test. If you need a refresher on what a standard hearing test includes, you can check out our post “Inside a Hearing Test: What Really Happens at Your Appointment.”

However, coverage doesn’t always extend to:

• Advanced testing
• Office visits
• Hearing aid consultations or maintenance

In healthcare, every service is billed using a specific code. When talking to your insurance provider, it’s important to mention that you’re seeing an audiologist, not a medical doctor. That distinction matters more than most people realize.

Audiologist vs. Physician: What’s the Difference in Billing?

An audiologist is a hearing specialist, not an MD. Audiologists hold a doctoral degree in their field and use the designation, Au.D.

But here’s the catch: because audiologists are considered specialists, many insurance plans apply a specialty copay or may not cover the visit at all. Medicare, for example, does not cover audiology office visits.

Using Medicare as an Example

Because so many private plans follow Medicare’s lead, it’s a useful starting point.

Medicare will cover:

• 92557 – Standard hearing test

But it does not cover:

• 99202 – Office visit / discussing results / hearing aid options / referral recommendations

So, if your provider only performed what Medicare covers, your appointment would be little more than sitting in the booth, taking the test, and walking out without any explanation or guidance. Not ideal, and not how we take care of patients.

Other important codes to be aware of:

• 92591 – Hearing aid selection/evaluation
• 92593 – Hearing aid check
• V5014 – Hearing aid repair

If you’re using Medicare, this falls under non-covered charges, meaning Medicare will not cover these codes and that becomes the patient’s responsibility. Some private insurance companies may cover a portion of a few of these codes, but never the full amount.

Our team always verifies insurance using every code that could be used during your appointment, which allows us to give you the most accurate estimate possible. Still, insurance is never an exact science, and not every code is used for every patient.

Does Insurance Cover Hearing Aids?

Here’s the big question, and unfortunately, the answer many people don’t want to hear:

Medicare does not cover hearing aids.

Hearing is still considered a “non-essential” sense (we disagree, of course), and the introduction of over-the-counter hearing aids hasn’t helped change that classification. Some Medicare replacement plans offer third-party discounts, but these are not true benefits. They often limit the technology or brands your provider can offer.

Your audiologist will always explain your options honestly, but ultimately, you decide how you want to move forward.

What About Private Insurance?

Some private insurance plans do offer direct benefits for hearing aids but be cautious. Direct benefits almost never cover the entire cost of devices.

For example, a plan might state:

“One device per ear every three years.”

Sounds generous, right? But this doesn’t mean full coverage.

That benefit is tied to the insurance company’s fee schedule, which is the maximum amount they’ll pay per code. And insurers don’t share their fee schedules with us. We make educated estimates based on experience and past claims, but your actual out-of-pocket amount also depends on:

• Your deductible
• Your max out-of-pocket balance
• Whether you’ve met either of those for the year

It’s complicated, we get it. And we’re always here to help you navigate it with as much clarity as possible.

Final Thoughts

Insurance may feel like a maze, but you don’t have to walk through it alone. Our team works hard to give you accurate estimates, explain your options clearly, and help you make the best choices for your hearing health, without surprises.

If you found this breakdown helpful, be sure to explore the rest of our patient education series. We cover everything from hearing tests to tinnitus to device options, all designed to make your hearing journey easier, clearer, and more empowering. Your next step might be just one blog post away.