Blue Cross Blue Shield coverage for hearing aids varies by plan and state

Blue Cross Blue Shield (BCBS) does cover hearing aids under many plans, but the amount and type of coverage depends on which specific plan you have, which state you live in, and whether your plan is through your employer, Medicare, or the individual market. Some BCBS plans cover hearing aids fully or partially; others cover them only after you meet a deductible; and some plans do not cover them at all. The only way to know what your plan covers is to check your plan documents or call the member services number on your insurance card.

BCBS is not a single insurance company — it is a network of independent insurance companies that use the Blue Cross Blue Shield name. Each company sets its own coverage rules within its state. A BCBS plan in California may cover hearing aids differently than a BCBS plan in Texas. This means you cannot assume your coverage based on what someone else with BCBS paid.

Key Takeaways

  • Blue Cross Blue Shield hearing aid coverage is set by your specific plan, not by the BCBS brand, so you must check your own plan documents or call your member services number.
  • Many BCBS plans cover 50 to 80 percent of the cost of hearing aids after you meet your deductible, but some cover nothing and some cover the full cost.
  • Medicare Advantage plans through BCBS often include hearing aid coverage, while Original Medicare does not cover hearing aids at all.
  • You will usually need a referral from your primary care doctor or an audiologist's prescription before BCBS will cover any hearing aid costs.
  • In-network hearing aid providers typically cost you less out of pocket than out-of-network providers, so ask your plan which providers are in network before you buy.

How to find out what your BCBS plan covers

Start by looking at your plan documents. If you have coverage through an employer, your human resources or benefits department can send you the plan summary or direct you to the online benefits portal. If you bought your plan on the individual market, log into your BCBS account online or look for the documents you received when you enrolled. If you have a Medicare Advantage plan through BCBS, your plan documents came in the mail when you first enrolled or during open enrollment.

Search the documents for "hearing aids" or "durable medical equipment" (hearing aids are often listed under this category). The plan will tell you whether hearing aids are covered, what percentage you pay, what your out-of-pocket maximum is, and whether you need a referral or prescription first.

If you cannot find the answer in your documents, call the member services number on the back of your insurance card. Tell them you want to know whether your plan covers hearing aids, what percentage of the cost you pay, and whether you need a referral. Write down the name of the person you spoke with and the date, in case you need to refer back to the conversation later.

Coverage differences between BCBS plan types

Employer-sponsored BCBS plans vary widely. Some large employers negotiate hearing aid coverage as part of their benefits package; others do not. Your employer's plan design determines what you pay. If your employer offers multiple plan options (such as a standard plan and a high-deductible plan), the hearing aid coverage may differ between them.

Medicare Advantage plans through BCBS often include hearing aid coverage, though the amount varies. Some plans cover one pair of hearing aids per ear every two or three years; others cover a set dollar amount per year. Original Medicare does not cover hearing aids, so if you are on Original Medicare, you would need to buy hearing aids out of pocket or look into state programs or nonprofit organizations that help seniors pay for them.

Individual market BCBS plans (plans you buy yourself, not through an employer) may or may not cover hearing aids. Some states require insurers to cover hearing aids; others do not. Check your plan documents or call to confirm.

What you typically pay out of pocket

If your BCBS plan covers hearing aids, you will usually pay a percentage of the cost after you meet your annual deductible. Common coverage levels are 50 percent, 60 percent, or 80 percent of the cost. Some plans set an annual maximum — for example, they may cover up to $2,000 per year for hearing aids. Once you reach that maximum, you pay the rest yourself.

In-network hearing aid providers are contracted with your BCBS plan and typically charge less than out-of-network providers. If you use an in-network provider, your out-of-pocket cost is usually lower. If you use an out-of-network provider, you may pay more, and your plan may cover a smaller percentage of the cost or none at all.

Ask your BCBS plan which hearing aid providers are in network before you schedule an appointment. Many plans have a list on their website or can tell you over the phone. Some plans work with national chains like Costco Hearing Aid Centers, Miracle-Ear, or Audibel; others contract with independent audiologists in your area.

Referrals and prescriptions your plan may require

Most BCBS plans require a referral from your primary care doctor or a prescription from an audiologist or ear, nose, and throat (ENT) doctor before they will cover hearing aids. This means you cannot straightforward walk into a hearing aid store and buy a pair — you need to see a doctor first.

Start by scheduling an appointment with your primary care doctor. Tell them you think you may need hearing aids. They can refer you to an audiologist or ENT specialist, or they may perform a basic hearing screening themselves. If they refer you to a specialist, that referral is what your BCBS plan will need to see before approving coverage.

The audiologist or ENT will do a full hearing test, discuss your hearing loss, and write a prescription or recommendation for hearing aids if they think you need them. Bring this prescription to your hearing aid provider. Your provider will submit it to your BCBS plan along with the cost estimate, and the plan will tell you what they will cover.

What to do if your BCBS plan does not cover hearing aids

If your plan does not cover hearing aids, you have several options. You can buy hearing aids out of pocket — prices range widely depending on the type and features, from around $1,000 to $6,000 per pair. Some hearing aid providers offer payment plans or discounts if you pay cash.

You can also look into other programs that help pay for hearing aids. Some states have programs for seniors or people with low income. Nonprofit organizations like the Hearing Loss Association of America or the American Speech-Language-Hearing Association can point you toward programs in your state. Costco and some other retailers offer hearing aids at lower prices than traditional hearing aid stores, which may make them more affordable even without insurance coverage.

If you are on Medicare and your BCBS Medicare Advantage plan does not cover hearing aids, you might be able to switch to a different Medicare Advantage plan during open enrollment (October 15 to December 7 each year) that does cover them. You can compare plans on Medicare.gov to see which ones in your area include hearing aid coverage.

How to submit a claim or get preapproval

Before you buy hearing aids, ask your hearing aid provider whether they can submit a preapproval request to your BCBS plan. Preapproval means the plan tells you in advance what they will cover, so you know your out-of-pocket cost before you buy. This protects you from surprises.

Your provider will need your insurance information, your doctor's referral or prescription, and the cost estimate for the hearing aids you want. They send this to your BCBS plan, and the plan responds with an approval letter that says how much they will cover. Keep this letter — you will need it when you pay your bill.

After you buy the hearing aids, your provider usually submits the claim to your BCBS plan on your behalf. You pay your out-of-pocket share (your deductible, coinsurance, or copay) directly to the provider. The provider bills your plan for the rest. If the provider does not submit the claim for you, you can submit it yourself by sending your receipt and the preapproval letter to the address on your plan documents.

Frequently Asked Questions

Does BCBS cover hearing aid batteries and repairs?

Coverage for batteries and repairs varies by plan. Some plans cover them as part of hearing aid coverage; others do not. Check your plan documents or call member services to ask whether batteries, repairs, and follow-up appointments with your audiologist are covered. Many plans cover the initial hearing aids but not the ongoing maintenance.

What if my hearing aids cost more than what BCBS will cover?

You pay the difference out of pocket. If your plan covers 80 percent of a $3,000 pair of hearing aids, they pay $2,400 and you pay $600. If you choose a more expensive pair, you pay the extra cost yourself. Ask your provider for the total cost upfront so you know what to expect.

Can I use my BCBS coverage at any hearing aid store?

Only at in-network providers, unless your plan allows out-of-network coverage. Call your plan or check their website for a list of in-network hearing aid providers in your area. Using an out-of-network provider may mean you pay more or that your plan covers a smaller percentage.

Do I need to switch BCBS plans to get hearing aid coverage?

If your current plan does not cover hearing aids, you can switch during open enrollment. For employer plans, this depends on your employer's enrollment period. For Medicare Advantage, you can switch during the annual open enrollment period from October 15 to December 7. For individual market plans, you can switch during the annual open enrollment period (usually November 1 to January 15) or if you have a may have access to life event.

Will BCBS cover hearing aids if I have not seen a doctor yet?

No. You need a referral from your primary care doctor or a prescription from an audiologist or ENT before your plan will cover hearing aids. Schedule a doctor's appointment first, get the referral, and then contact a hearing aid provider. The provider can then submit the referral to your plan for preapproval.