Medi-Cal covers hearing aids, but only through specific programs and with restrictions that vary by age and county

Medi-Cal, California's Medicaid program, does cover hearing aids for children under 21 and for adults over 64 without income limits. For working-age adults between 21 and 64, coverage depends on which Medi-Cal plan you have — some managed care plans cover them, others do not. The state does not cover hearing aids for most adults aged 21 to 64 who are on traditional fee-for-service Medi-Cal, though this rule has exceptions for specific medical conditions.

The actual process requires a referral from your primary care doctor to an audiologist or ear, nose, and throat specialist, and the hearing aid must be ordered through a Medi-Cal-contracted provider. Medi-Cal typically covers one hearing aid per ear every five years, though children may receive replacements more frequently if their hearing changes or they outgrow their devices.

Key Takeaways

  • Children under 21 and adults 64 and older have Medi-Cal hearing aid coverage without income restrictions, but working-age adults usually do not unless they are on a managed care plan that includes it.
  • You must get a referral from your primary care doctor before seeing an audiologist, and the audiologist must be contracted with Medi-Cal in your county.
  • Medi-Cal covers one hearing aid per ear every five years for most beneficiaries, though children may get replacements sooner if medically necessary.
  • Your county Medi-Cal office and your managed care plan (if you have one) are the only sources that can tell you whether your specific situation qualifies for coverage.

Who qualifies for Medi-Cal hearing aid coverage

Children under 21 automatically may have access to for hearing aid coverage through Medi-Cal's Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. This program covers hearing aids as medically necessary devices for children, with fewer restrictions than coverage for adults.

Adults aged 64 and older may have access to for hearing aid coverage regardless of income, as long as they are enrolled in Medi-Cal. This is one of the few Medi-Cal services with no income cap for seniors.

Working-age adults between 21 and 64 face the most restrictions. If you are on a Medi-Cal managed care plan (such as a health maintenance organization or HMO), check your plan's coverage documents or call the plan directly — some plans do cover hearing aids, others do not. If you are on traditional fee-for-service Medi-Cal, the state generally does not cover hearing aids unless you have a specific medical condition that makes them medically necessary, such as sudden hearing loss from an injury or infection.

How to start the process with your doctor

Your first step is to contact your primary care doctor and tell them you need a hearing evaluation. Your doctor will assess whether a hearing aid is medically necessary and, if so, write a referral to an audiologist or otolaryngologist (ear, nose, and throat specialist) who accepts Medi-Cal.

When you call your doctor's office, ask them to confirm that they will refer you to a Medi-Cal-contracted provider in your county. Not all audiologists and specialists accept Medi-Cal, and using an out-of-network provider means Medi-Cal will not cover the cost. Your doctor's office should have a list of in-network providers, or you can call your county Medi-Cal office to ask which audiologists in your area are contracted.

Bring your Medi-Cal card and a photo ID to your doctor's appointment. If you do not have a primary care doctor, contact your county Medi-Cal office or your managed care plan to request one.

What happens at the audiologist appointment

The audiologist will perform a hearing test to measure your hearing loss and determine whether a hearing aid will help. They will also check whether you have any medical conditions that would prevent you from wearing a hearing aid safely. This appointment is usually covered by Medi-Cal at no cost to you.

If the audiologist recommends a hearing aid, they will submit a request to Medi-Cal for coverage. Medi-Cal will review the request and the audiologist's documentation to decide whether to cover the device. This review typically takes one to two weeks. The audiologist's office will contact you once Medi-Cal makes a decision.

If Medi-Cal approves the hearing aid, the audiologist will order it and fit it to your ear. You will not pay for the device itself, but you may pay a small copay at the time of the appointment, depending on your Medi-Cal plan. The audiologist will also provide follow-up appointments to adjust the hearing aid and make sure it is working correctly.

Coverage limits and what you pay out of pocket

Medi-Cal covers one hearing aid per ear every five years. If you need a replacement before five years have passed, you will have to pay for it yourself unless Medi-Cal determines the replacement is medically necessary — for example, if your hearing has changed significantly or the device is broken and cannot be repaired.

Children may receive replacements more frequently than every five years if their hearing changes as they grow or if their device no longer fits. Ask your audiologist whether your situation qualifies for an exception.

You may have a copay for the audiologist's appointment and fitting, usually between $0 and $10 depending on your Medi-Cal plan. The hearing aid itself is covered at no additional cost once Medi-Cal approves it. Batteries, repairs, and maintenance are typically not covered by Medi-Cal, so you will pay for those out of pocket.

If Medi-Cal denies coverage

If Medi-Cal denies your request for a hearing aid, the audiologist's office should give you a written explanation of the reason. Common reasons for denial include: the audiologist determined a hearing aid would not help your specific type of hearing loss, you do not meet your plan's medical necessity criteria, or you are a working-age adult on fee-for-service Medi-Cal without a may have access to condition.

You have the right to request a reconsideration. Ask the audiologist's office to submit additional documentation or a letter from your doctor explaining why the hearing aid is medically necessary. You can also file a formal appeal with your county Medi-Cal office or your managed care plan within 30 days of the denial. Contact your county Medi-Cal office for the appeal form and instructions.

If you are denied and cannot afford a hearing aid, ask your audiologist about sliding-scale programs, nonprofit organizations that distribute hearing aids, or state vocational rehabilitation services if you are working or looking for work.

Differences between Medi-Cal managed care and fee-for-service

Medi-Cal managed care plans are run by private health insurance companies under contract with the state. Each plan sets its own coverage rules within state guidelines. Some managed care plans cover hearing aids for working-age adults; others do not. You must check your specific plan's coverage documents or call the plan's customer service number to find out.

Fee-for-service Medi-Cal is run directly by the state. The state's standard policy does not cover hearing aids for working-age adults unless they have a specific medical condition. If you are on fee-for-service Medi-Cal and want to know whether your condition qualifies, call your county Medi-Cal office and ask to speak with someone in the medical review unit.

If you are on a managed care plan that does not cover hearing aids, you can request to switch to a different plan during the annual open enrollment period (usually November through January) or if you have a may have access to life event, such as moving to a new county.

Frequently Asked Questions

Do I need a referral from my doctor to see an audiologist?

Yes, Medi-Cal requires a referral from your primary care doctor before you see an audiologist. Without a referral, Medi-Cal will not cover the audiologist's evaluation or any hearing aid that results from it. Call your doctor's office and ask them to send a referral to a Medi-Cal-contracted audiologist in your area.

What if I am on a managed care plan and it does not cover hearing aids?

You can request to switch to a different Medi-Cal managed care plan during the annual open enrollment period (usually November through January) if another plan in your county covers hearing aids. You can also switch if you have a may have access to life event, such as moving. Contact your current plan or your county Medi-Cal office to request a change.

How long does it take to get a hearing aid once Medi-Cal approves it?

The audiologist usually orders the hearing aid after Medi-Cal approves coverage. Delivery typically takes one to three weeks, depending on the type of hearing aid and the manufacturer. The audiologist will contact you once the device arrives and schedule a fitting appointment.

Can I choose which hearing aid I want, or does Medi-Cal limit my options?

Medi-Cal covers hearing aids up to a certain price limit, which varies by county and plan. The audiologist will show you options within that limit. If you want a more expensive hearing aid, you can pay the difference out of pocket. Ask the audiologist what the Medi-Cal coverage limit is for your county before you choose a device.

What if my hearing aid breaks and I need a replacement before five years?

If your hearing aid breaks and cannot be repaired, contact your audiologist when ready. They can submit a request to Medi-Cal for a replacement, explaining that the device is no longer functional. Medi-Cal may cover a replacement if the device is beyond repair. If Medi-Cal denies the request, you will have to pay for a replacement yourself or look into nonprofit hearing aid programs.